Problems of poststreptococcal diseases primary prophylaxis - lessons of a multicenter study management practice of patients with acute tonsillitis

Objective. To evaluate the actual practice of diagnostics and treatment of patients with acute tonsillitis in order to assess the quality of primary prophylaxis of poststreptococcal diseases in different regions of Russia. Material and methods. The medical charts of 1333 adult outpts with acute tonsillitis in seven cities were analyzed. The data on each pts such as demographics, case history, bacteriological examinations results, prescribed medications, adverse events and outcomes of therapy were documented in case record forms. Data management was carried out using software. Results. Microbiological identifications of group A-streptococcus (GAS) were performed only in 0,3% of analyzed cases, so diagnosis of tonsillitis was based commonly on clinical data. Systemic antimicrobial drugs were prescribed to 95,3% of pts, among them to 91,5% as monotherapy and to 3,8% as combined therapy. Ampicillin was the most often initial antimicrobial (45,0%), other relatively frequently prescribed drugs were erythomycin (19,1%), ciprofloxacin (7,0%), doxycycline (5,6%), amoxycillin (5,2%), midecamycin (4,4%), ampicillin/oxacillin (3,2%). Two courses of antimicrobials were used in 8,5% of pts. The average duration of antibacterial therapy was 7,4 ± 3,4 days. The adverse events were noted in 0,9% of analyzed cases. Conclusion. The main problems of primary prophylaxis of poststreptococcal diseases were: (1) the diagnosis of tonsillitis without microbiological GAS identification, (2) prescribing antimicrobials without consideration of appropriate recommendation and (3) the lack of pathogen eradication control.

poststreptococcal diseases, prophylaxis, acute tonsillitis, group A-streptococcus, antimicrobial therapy

1. <div><p>Насонова В.А., Белов Б.С., Страчунский Л.С. и др. Антибактериальная терапия стрептококкового тонзиллита и фарингита. Клин, микробиол. антимикроб, химио- тер. 1999, 1, 78-82</p><p>Gwaltney J.M., Bisno A.L. Pharyngitis. In: Mandell G.L., Bennett J.E., Dolin R. (eds.) Principles and Practice of Infectious Diseases. 5th ed. Philadelphia: Churchill Livingstone, 2000, 656-662</p><p>Stollerman G.H. Rheumatic fever. Lancet, 1997, 349, 935942.</p><p>Белов B.C., Насонова B.A., Гришаева Т.П. Ревматологические аспекты стрептококкового тонзиллита и современные подходы к его антибактериальной терапии. Клин, микробиол. антимикроб, химиотср., 2000, 2, 52­56</p><p>Gerber М.А. Diagnosis and treatment of group A streptococcal pharyngitis. Ped. Infect. Dis., 1998, 9, 42-49</p><p>Clements D.A. Pharyngitis, Laryngitis, Epiglottitis. In: Armstrong D., Cohen J. (eds.) Infectious Diseases. London: Harcourt Publishers Ltd, 1999, I, 24.1-24.6</p><p>Bisno A.L., Gerber M.A., Gwaltney J.M. et al. Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Clin. Infect. Dis., 2002, 35, 113125</p><p>Mandell G.L., Perty W.A.Jr. Penicillins, Cephalosporines and other b-lactam antibiotics. In: Hardman J.G., Limbird L.E., Molinoff P.B., Ruddon R.W. (eds.) The Pharmacological Basis of Therapeutics. 9th ed. New York: McGraw-Hill, 1996, 1073-1102</p><p>Brook I. The role of b-lactamase producing bacteria and bacterial interference in streptococcal tonsillitis. Intern. J. Antimicrob. Agents, 2001, 17, 439-442</p><p>Страчунский Л.С., Козлов C.H. Макролиды в современной клинической практике. Смоленск, Русич, 1998</p><p>Sivaja O.V., Kozlov R.S., Stratchounski L.S and PEHASus Project Group. Current state of antimicrobial resistance of S. pyogenes (GAS) in Russia: results of prospective multicenter study (PeGASus-I, phase "B"). Proceedings of the 1st FEMS Congress of European Microbiologists, 2003, June 29-July 3, Ljubljana, Slovenia. Amsterdam, Elsevier, 2003</p><p>Standiford H.C. Tetracyclines and chloramphenicol. In: Mandell G.L., Bennett J.E., Dolin R. (eds.) Principles and Practice of Infectious Diseases. 5th ed. Philadelphia etc.: Churchill Livingstone, 2000, 336-348</p><p>Thauvin-Eliopoulos C., Eliopoulos G.M. Activity in vitro of the quinolones. In: Hooper D.C., Rubinstein E. (eds.) Quinolone Antimicrobial Agents. 3rd ed. Washington: ASM Press, 2003, 91-111</p><p>Zinner S.H., Mayer K.H. Sulphonamides and trimethoprim. In: Mandell G.L., Bennett J.E., Dolin R. (eds.) Principles and Practice of Infectious Diseases. 5th ed. Philadelphia etc.: Churchill Livingstone, 2000, 394-404</p><p>Профилактика стрептококковой (группы А) инфекции. Санитарно-эпидемиологические правила. СП, 3.1.2.1203-03, 2003.</p></div><br />