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

Abstract

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.

Keywords

• poststreptococcal diseases
• prophylaxis
• acute tonsillitis
• group a-streptococcus
• antimicrobial therapy