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ISSN 0120-8411 (Print)
Asociación Colombiana de Otorrinolaringología y Cirugía de Cabeza y cuello, Maxilofacial y Estética Facial (ACORL)

2022, Number 4

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Acta de Otorrinolaringología CCC 2022; 50 (4)

Evaluation of adherence to the clinical practice guideline for the management of acute pharyngotonsillitis in the emergency care of the University Hospital San Ignacio, Bogota, Colombia

Ospina-García JC, Villegas-Echeverri MC, Núñez N, Rodríguez-Ruiz MT, López J, Gutiérrez-Maldonado S

Language: Spanish
References: 13
Page: 280-284
PDF size: 184.92 Kb.


ABSTRACT

Objective: Sore throat is one of the most frequent complaints in the ER, both in children and adults. Although it has been established that most cases of acute tonsillitis are caused by viruses, given the difficulty in identifying its etiology based exclusively upon clinical signs, the indiscriminate prescription of antibiotics in the emergency setting has become very frequent. This practice may lead to the emergence of antibiotic resistance and secondary effects. We evaluated the adherence of ER physicians to clinical practice guidelines for the management of acute tonsillitis at Hospital Universitario San Ignacio in Bogotá, Colombia. Methods: A retrospective descriptive study was carried out. Clinical records for emergency visits between the years of 2016 and 2019 were reviewed. Data regarding rapid antigen detection test for GABHS (RAD), antibiotic and analgesic prescription and tonsillar exudates on physical exam, were recorded. Results: 7.762 patients with acute tonsillitis were included in the study. 74,2% were prescribed antibiotics and 98% received pain medication. For 11,53% of cases the rapid antigen test for GABHS was requested. Although tonsillar exudates are the main factor associated with the formulation of antibiotics, only 21% of rapid antigen detection tests were positive. As such, the systemic use of rapid diagnostic tests may help reduce unnecessary antibiotic prescription, bacterial resistance and drug side effects.


REFERENCES

  1. Cag Y, Ozdemir AA, Yukselmis U, Akdeniz E, Ozcetin M.Association Between Rapid Antigen Testing and AntibioticUse and Accuracy of Peripheral Blood Parameters in DetectingGroup A Streptococcus in Children with Tonsillopharyngitis.Front Pediatr. 2019;7:322. doi: 10.3389/fped.2019.00322

  2. Shaikh N, Leonard E, Martin JM. Prevalence of streptococcalpharyngitis and streptococcal carriage in children: a metaanalysis.Pediatrics. 2010;126(3):e557-64. doi: 10.1542/peds.2009-2648

  3. Shaikh N, Swaminathan N, Hooper EG. Accuracy and precisionof the signs and symptoms of streptococcal pharyngitis inchildren: a systematic review. J Pediatr. 2012;160(3):487-493.e3. doi: 10.1016/j.jpeds.2011.09.011

  4. Ospina JC, Mantilla N, Mateus C. Guía para el manejo defaringoamigdalitis. Hospital Universitario San Ignacio; 2015.

  5. Cardoso DM, Gilio AE, Hsin SH, Machado BM, de PaulisM, Lotufo JP, et al. Impact of the rapid antigen detection testin diagnosis and treatment of acute pharyngotonsillitis in apediatric emergency room. Rev Paul Pediatr. 2013;31(1):4-9.doi: 10.1590/s0103-05822013000100002

  6. Randel A. AAO-HNS Guidelines for Tonsillectomy in Childrenand Adolescents. Am Fam Physician. 2011;84(5):566-73.

  7. National Institute for Health and Care Excellence (NICE).Sore throat (acute): antimicrobial prescribing (NICE QualityStandard No. 84). 2018. Disponible en: https://www.nice.org.uk/guidance/ng84/resources/sore-throat-acute-antimicrobialprescribing-pdf-1837694694085

  8. Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL,Lee G, et al. Clinical practice guideline for the diagnosis andmanagement of group A streptococcal pharyngitis: 2012 updateby the Infectious Diseases Society of America. Clin Infect Dis.2012;55(10):1279-82. doi: 10.1093/cid/cis847

  9. Llor C, Madurell J, Balagué-Corbella M, Gómez M, Cots JM.Impact on antibiotic prescription of rapid antigen detectiontesting in acute pharyngitis in adults: a randomised clinicaltrial. Br J Gen Pract. 2011;61(586):e244-51. doi: 10.3399/bjgp11X572436

  10. Holub M, Beran O, Kaspríková N, Chalupa P. Neutrophil tolymphocyte count ratio as a biomarker of bacterial infections.Cent Eur J Med. 2012;7:258-61. doi: 10.2478/s11536-012-0002-3

  11. Cohen JF, Bertille N, Cohen R, Chalumeau M. Rapid antigendetection test for group A streptococcus in children withpharyngitis. Cochrane Database Syst Rev. 2016;7(7):CD010502.doi: 10.1002/14651858.CD010502.pub2

  12. Gieseker KE, Mackenzie T, Roe MH, Todd JK. Comparisonof two rapid Streptococcus pyogenes diagnostic tests with arigorous culture standard. Pediatr Infect Dis J. 2002;21(10):922-7. doi: 10.1097/00006454-200210000-00007

  13. National Institute for Health and Care Excellence (NICE).Antimicrobial stewardship: systems and processes for effectiveantimicrobial medicine use. 2015. Disponible en: https://www.nice.org.uk/guidance/ng15/resources/antimicrobialstewardship-systems-and-processes-for-effectiveantimicrobial-medicin




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