Optimization of clinical diagnosis and treatment of acute tonsillopharyngitis in children

Abstract

Introduction. Administration of antibiotics in case of acute tonsillopharyngitis (ATP) is reasonable only when the disease is caused by β-hemolytic streptococcus of A (BHSA) group, although clinical confirmation of its etiology is rather complicated. Objective. Improvement of the diagnosis and treatment of acute tonsillopharyngitis in children, considering the etiological factor and the clinical characteristics of the course of this disease. Materials and methods. 102 children with acute tonsillopharyngitis were included in the study. The patients were divided in 2 groups. The first group included 68 patients with non-streptococcal acute tonsillopharyngitis (nATP), the second one – 34 children with streptococcal acute tonsillopharyngitis (sATP) with BHSA. The study was performed in the Children Regional Hospital, Chernivtsi, Ukraine, during the period 2014-2016. General clinical examination was performed in all the children, using MacIsaac, Centor and Breeze probabilistic-orientation clinical systems. Constellation pattern of ATP was simulated by successive Waald’s method in Kulbak’s modification. Results. MacIsaac and Centor clinical systems, with the total sum less than 3, with a specificity of 93.9% and a sensitivity of 12.5%, were indicative of non-streptococcal acute tonsillitis in children. The prospective 1-year observation of children who had ATP determined that every third child from the 1st group and half of the representatives from the 2nd group presented different complaints associated with vegetative-vascular dystonia syndrome. In case of impossible microbiological examination in patients with ATP, we have suggested the algorithm of a rational administration of antibiotics for its treatment. Conclusions. MacIsaac and Centor probabilistic-orientation clinical systems with the total sum of less than 3 are indicative of non-streptococcal acute tonsillitis in children, with a high specificity, but low sensitivity. Therefore, according to our research, to reduce the risk of insufficient diagnosis of acute tonsillopharyngitis caused by β-hemolytic streptococcus when microbiological examination is not possible, a multilevel algorithm for its treatment should be used.

Keywords

• children
• acute non-streptococcal
• streptococcal tonsillopharyngitis