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"Child`s Health" 8 (51) 2013

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Acute streptococcal tonsillitis in children.The questions that are posed by life. (Answers to the science questions, that are posed by the practice).

Authors: Nagorna N.V., Bordyugova O.V., Koval O.P. - Donetsk National Medical University n.a. M. Gorky. Department of Pediatrics of Training and Research Institute of Post-Graduate Education Ukraine

Categories: Pediatrics/Neonatology

Sections: Specialist manual

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The problem of acute tonsillitis remains relevant in clinical pediatrics. In this article is presented an analysis of the clinical case of streptococcal tonsillitis in children, discussed the validity of the diagnosis and treatment strategy.

Acute tonsillitis as one of the most common infectious diseases of the upper respiratory tract, has numerous pathogens. A special role of it etiology belong to group A β-hemolytic streptococcus (GABHS, Streptococcus pyogenes), which is found in one of four children with acute bacterial tonsillitis. It is known that the sources of streptococcal infection are sick persons  and less asymptomatic carrier. The natural reservoir of this pathogen are skin and mucous membranes. GABHS is transmitted by airborne way. According to results of American researchers, every child who has attained the age of 5 years, has a case of GABHS infection of the pharynx, and at the age of 13 years, the number of episodes of the disease reaches three times. Asymptomatic carriers of the pathogen in the fauces was noted in 15 - 20% of children that is more frequently in comparison with adults (5%). Streptococcal infection affects mainly children aged 5-15 years, both girls and boys in equal measure.

GABHS tonsillitis is a self-limiting disease, the clinical symptoms may disappear after few days, even without treatment. However, this infectious pathology is characterized by a significant incidence and severity of various complications.

The diagnosis of GABHS tonsillitis, should be confirmed by microbiological examination of smears from the surface of the tonsils and/or of the throat . Currently, Canadian researchers developed and tested on a large group of patients, the clinical algorithm which at the first examination, the patient assume the presence of GABHS infection of the pharynx and accordingly decide on the advisability of empirical antibiotic treatment for inability to perform microbiological testing

As in European countries, the USA, and in Ukraine if a child has an acute streptococcal tonsillitis is an absolute indication for antibiotic therapy. In this case, important is choice of antibiotic and duration of it course. The aim of  the antibiotic treatment - eradication of the pathogen and relief of clinical symptoms of the disease.

First-line drugs in the treatment of streptococcal tonsillitis both abroad and in our country are the β-lactams (penicillin and cephalosporin) to which GABHS doesn’t have resistance. Because GABHS not emit penicillinase as other pathogens. The antibacterial activity of cephalosporin’s is due to inhibition of peptidoglycan synthesis - a framework of microbial wall. It is important to remember that the bactericidal effect of cephalosporin’s is realized only in the process of growth and reproduction of microorganisms, while "resting” immune cells are not vulnerable for the antibiotic action.

Cephalosporin of second generation are more resistant to β-lactamase, while maintaining high activity for gram-positive bacteria, including streptococci.

For characteristic second generation of cephalosporin’s balance antimicrobial activity against gram-positive and gram-negative flora combined with good tolerability and safety, which is particularly important in the empirical therapy.

Zinnat (cefuroxime axetil) is the original (branded) drug, which is important in the characterization of its efficacy and safety. Its feature is that, in its chemical structure has an oxime group, which provides resistance to β-lactamases. This ensures high efficiency in the treatment of infections caused by pneumococci, haemophilusinfluenzae, morakselloy, staphylococci and GABHS whether they produce β- lactamase or less.

An analysis of medical records indicates that in recent years have been increasingly prescribe of third generation of cephalosporin’s in the treatment of streptococcal tonsillitis, explaining that a wide spectrum of action in the absence of the pathogen culture results in the patient. However, the activity of cephalosporin of second generation, in particular, cefuroxime axetil against streptococci, including GABHS  and pneumococc and not let to that of third generation cephalosporin’s , but they are more active against gram- flora.

 Streptococcal tonsillitis is still relevant in the children’s infection pathology,  requires from pediatrician, family doctor, otolaryngologist vigilance and prescripyion of adequate treatment. The combination of competent medical conclusion, prescription and use of the most effective antibiotics contribute to the preservation and restoration of health of the young generation of Ukraine. Zinnat may be the drug of choice in the treatment of infections caused by Streptococcus pyogenes.

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