Clinical efficacy of a screening approach to the differentiated prescription of antibiotic therapy in children with acute tonsilopharyngitis

Abstract

Aim. To assess the effectiveness of the screening approach by prescribing a streptotest to verify the etiological cause of tonsillopharyngitis in children. Methods. We observed 67 patients aged 7 to 11 with a history of recurrent respiratory infections. The incidence of acute respiratory infections varied from 8 to 12 times during the year preceding the examination. The main group consisted of 36 children who had tonsillopharyngitis with severe inflammation of the tonsils and plaque on the tonsils. The control group included 31 patients with acute tonsillopharyngitis with inflammatory changes in the tonsils and the absence of plaque. The observation and control groups were comparable and did not have statistically significant differences in gender and age. All patients underwent a common clinical, laboratory, and instrumental examination. Along with microbial culture, the special examinations included an express test (Dectra Pharm, France) for the presence of group A -hemolytic streptococcus. Results. All children underwent an etiological examination. The presence of a viral antigen was confirmed in 71.64% of children. 27.49% of patients in the control group and 30.72% of patients in the main group had positive results of the express test for group A -hemolytic streptococcus, taking into account the requirements for assessing this reaction. It was revealed a reliable direct relationship between the detected viral infection and the negative results of the streptatest test (r=0.86; p=0.03) for the control group, and a positive correlation of the confirmed presence of group A -hemolytic streptococcus in the main group as with both C-reactive protein (r=0.78; p=0.04) and with inflammatory markers in the general blood test. A combination of positive fluorescence of viral antigens based on the results of immunofluorescence and a positive enzyme-linked immunosorbent assay (ELISA) for group A -hemolytic streptococcus was recorded in 7.46% of all patients. Clinical examples are given the justification of practical implementation of the express test for the quick diagnostic information. Conclusion. Differentiated etiological diagnosis of acute tonsillopharyngitis based on clinical symptoms and the levels of markers of bacterial inflammation is extremely difficult therefore laboratory criteria should be the justification for prescribing antibiotic therapy; currently, the most accessible is the streptatest for the detection of group A -hemolytic streptococcus, which allows confirming or denying the presence of group A -hemolytic streptococcus within a few minutes, which means that it is correct to prescribe antibacterial drugs to patients.