Pharmacotherapy of Pharyngitis, Sinusitis and Otitis Media

PST 06106

Basic Pharmacotherapy

Session 7: Pharmacotherapy of Pharyngitis, Sinusitis, and Otitis Media

Learning objectives

By the end of this session students are expected to be able to:

Define pharyngitis, sinusitis, and otitis media

Explain pathophysiology of pharyngitis, sinusitis, and otitis media

Explain the clinical presentation of pharyngitis, sinusitis, and otitis media

Outline diagnosis of pharyngitis, sinusitis, and otitis media

Describe pharmacological treatment of pharyngitis, sinusitis, and otitis media

Describe monitoring of pharyngitis, sinusitis, and otitis media therapy

Activity: Buzzing

•

What

is pharyngitis??

Definition of Pharyngitis, Sinusitis, and Otitis Media

Pharyngitis

is an acute infection of the oropharynx or nasopharynx.

It is caused by virus and bacteria

Viruses cause the majority of acute pharyngitis cases

Specific etiologies include rhinovirus, coronavirus, adenovirus, herpes simplex virus, influenza virus, parainfluenza virus, and Epstein-Barr virus

Group A

β

–hemolytic streptococci (GAS; also known as

S.

pyogenes

),

is the

primary

bacterial

cause.

Other, less-common causes of acute pharyngitis are groups C and G

Streptococcus, Corynebacterium

diphtheriae

, Neisseria gonorrhoeae, Mycoplasma pneumoniae,

Arcanobacterium

haemolyticum

, Yersinia

enterocolitica

, and Chlamydia pneumonia

Pathophysiology Of Pharyngitis

The mechanism by which

Group A beta haemolytic streptococci (GAS)

causes pharyngitis is not well defined

Asymptomatic pharyngeal carriers of the organism may have an alteration in host immunity (e.g., a breach in the pharyngeal mucosa) and the bacteria of the oropharynx, allowing colonization to become an infection

Pathogenic factors associated with the organism itself may also play a role

These include pyrogenic toxins,

hemolysins

, streptokinase, and

proteinase.

Clinical presentation and Diagnosis of Pharyngitis

General

A sore throat of sudden onset that is mostly self-limited

Fever and constitutional symptoms resolving in about 3 to 5 days

Clinical signs and symptoms are similar for viral causes and

nonstreptococcal

bacterial

causes

Clinical presentation and Diagnosis of

Pharyngitis

Cont

…

Signs and Symptoms

Sore throat ( pain or irritation in the throat that occurs with/without swallowing)

Pain on swallowing

Fever

Headache, nausea, vomiting, and abdominal pain (especially children)

Erythema/inflammation of the tonsils and pharynx with or without patchy exudates

Enlarged, tender lymph nodes

Red swollen uvula,

petechiae

on the soft palate, and a

scarlatiniform

rash

Several symptoms that are not suggestive of group A streptococci are cough, conjunctivitis,

coryza

, and diarrhea

Clinical presentation and Diagnosis of Pharyngitis

Cont

…

Signs Suggestive of Viral Origin for Pharyngitis

Conjunctivitis

Coryza (irritation and swelling of the mucous membrane in the nose)

Cough

Diarrhea

Laboratory Tests

Throat swab and culture

Rapid antigen detection testing (RADT)

Activity: Small Group Discussion

What

is the first line treatment of

Pharyngitis ?

Pharmacological treatment of Pharyngitis

The goals of treatment for pharyngitis are to;

Improve clinical signs and symptoms,

M

inimize

adverse drug reactions,

Prevent

transmission to close contacts, and

P

revent

acute rheumatic fever and suppurative complications, such as

peritonsillar

abscess, cervical lymphadenitis, and

mastoiditis

Pharmacological treatment of Pharyngitis

For recurrent

pharyngitis

Monitoring of Pharyngitis Therapy

Most pharyngitis cases are self-limited; however, antibiotics hasten resolution when given early for proven cases of

Group A beta hemolytic streptococci (GAS) pharyngitis

.

Generally, fever and other symptoms resolve within 3 or 4 days of onset without antibiotics; however, symptoms will improve 16 hours to 2 days earlier with antibiotic therapy.

Follow-up testing is generally not necessary for index cases or in asymptomatic contacts of the index patient.

However, for patients who remain symptomatic or when symptoms recur despite completion of treatment, posttreatment throat cultures 2 to 7 days after completion of antibiotics should be done

.

Key Points

Acute

pharyngitis is characterized by the rapid onset of sore throat and pharyngeal inflammation (with or without exudate). .

It can be caused by a variety of viral and bacterial pathogens, including group A Streptococcus (GAS),

Diagnosis can be done clinically especially and by using lab test

Most of the time the condition is self limiting, but antibiotics may be needed

Evaluation

What

is pharyngitis?

What are the signs and symptoms of pharyngitis?

How is pharyngitis diagnosed?

How is the treatment of pharyngitis

REFER Students to Handout 7.1: Pharmacotherapy of

Sinusitis

REFER Students to Handout 7.2: Pharmacotherapy of Otitis Media

References

Wells

BG,

DiPiro

J,

Schwinghammer

T (2013),

Pharmacotherapy Handbook

(6

th

Ed). New York, NY: McGraw-Hill.

DiPiro

JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008):

Pharmacotherapy: A Pathophysiologic Approach

(7

th

ed

): New York, NY: McGraw-Hill.

Katz M D., Matthias KR., Chisholm-Burns M A., Pharmacotherapy(2011)

Principles & Practice Study Guide: A Case-Based Care Plan Approach

: New York, NY: McGraw-Hill.

Schwinghammer

TL, Koehler JM (2009)

Pharmacotherapy Casebook: A Patient-Focused Approach

(7

th

ed

): New York, NY: McGraw-Hill.

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