Pharyngitis treatment

There have been two other case reports of photoallergic dermatitis after local pharyngeal treatment with formulations containing benzydamine (6). This presumably occurs because of oral or intestinal absorption. 

Local pharyngeal treatment with benzydamine hydrochloride 0.15% (Tantum verde) by a 67-year-old man resulted in systemic photocontact dermatitis in the third week of treatment (191). Photopatch tests with Tantum verde as is and in 10% aqueous solution were positive D1+, D2+, D3h—h. 

Still, J. G. (1995). Management of pediatric patients with group A beta-hemolytic Streptococcus pharyngitis Treatment options. Pediatr. Infect. Dis. J. 14, S57-61. 

Cidofovir (Fig. 2) has been formally approved for the treatment of CMV retinitis in AIDS patients, where it is administered intravenously at a dose not exceeding 5 mg/kg once weekly during the first two weeks (and every other week thereafter). Cidofovir is also used off label for the treatment of human papilloma virus (HPV) infections (i.e., cutaneous warts, anogenital warts, laryngeal and pharyngeal papilloma), polyomavirus [i.e., progressive (i.e., multifocal leukoencephalopathy (PML)], adenovirus, herpesvirus, and poxvirus (i.e., molluscum contagiosum) infections, where it can be administered intravenously (at a dose of < 5 mg/kg once weekly or every other week) or topically as a 1% gel or cream (De Clercq and Holy 2005). Especially in immunosuppressed patients (i.e., transplant recipients), local treatment of HPV-associated lesions has often yielded spectacular results (Bonatti etal.2007). 

Acute pharyngitis presents a diagnostic and therapeutic dilemma. The majority of sore throats are caused by a variety of viruses fewer than 20% are bacterial and hence potentially responsive to antibiotic therapy. However, antibiotics are widely prescribed and this reflects the difficulty in discriminating streptococcal from non-streptococcal infections clinically in the absence of microbiological documentation. Nonetheless, Strep, pyogenes is the most important bacterial pathogen and this responds to oral penicillin. However, up to 10 days treatment is required for its eradication fixm the throat. This requirement causes problems with compliance since symptomatic improvement generally occurs within 2-3 days. 

List treatment goals for acute otitis media, bacterial rhinosinusitis, and streptococcal pharyngitis. 

On further questioning, you discover that the child is allergic to penicillin. She developed a nonurticarial rash last year during treatment for pharyngitis. She has not received antibiotics since that time, and this is her first ear infection. Immunizations Up to date Meds... 

FIGURE 69-5. Treatment algorithm for management of pharyngitis in children and adults.45,46 aRapid antigen detection tests (RADTs) are preferred if the test sensitivity exceeds 80%. 

Treatment with these doses of radiotherapy involves toxicity. Both acute and late effects of radiotherapy occur. Acute effects of mantle-field irradiation include nausea, vomiting, anorexia, xerostomia, dysguesia, pharyngitis, dry cough, fatigue, diarrhea,... 

Infliximab (Remicade) is a chimeric monoclonal antibody directed against TNF-a. Recently, its indications have been expanded to include psoriatic arthritis and treatment of adults with chronic severe plaque psoriasis. An advantage over other systemic psoriasis treatments is that infliximab does not adversely affect blood counts, hepatic enzyme levels, or kidney function. The recommended dose is 5 mg/kg as an IV infusion at weeks 0, 2, and 6, then every 8 weeks thereafter. For psoriatic arthritis, it may be used with or without methotrexate. Adverse effects include headaches, fever, chills, fatigue, diarrhea, pharyngitis, upper respiratory and urinary tract infec-... 

Alefacept (Amevive) is a dimeric fusion protein that binds to CD2 on T cells to inhibit cutaneous T-cell activation and proliferation. It also produces a dose-dependent decrease in circulating total lymphocytes. Alefacept is approved for treatment of moderate to severe plaque psoriasis and is also effective for treatment of psoriatic arthritis. Significant response is usually achieved after about 3 months of therapy. The recommended dose is 15 mg intramuscularly once weekly for 12 weeks. Adverse effects are mild and include pharyngitis, flu-like symptoms, chills, dizziness, nausea, headache, injection site pain and inflammation, and nonspecific infection. 

The goals of treatment of pharyngitis are to improve clinical signs and symptoms, minimize adverse drug reactions, prevent transmission to close... 

Most cases of pharyngitis are self-limited however, antimicrobial therapy will hasten resolution when given early to proven cases of group A Streptococcus. Symptoms generally resolve by 3 to 4 days even without therapy. Children should be kept home from daycare or school until afebrile and for the first 24 hours after antimicrobial treatment is initiated,... 

Primary axillary hyperhidrosis Adverse events (in at least 3% of patients) included injection site pain and hemorrhage, nonaxillary sweating, infection, pharyngitis, flu syndrome, headache, fever, neck or back pain, pruritus, and anxiety. Blepharospasm The most frequently reported treatment-related adverse reactions were ptosis (20.8%), superficial punctate keratitis (6.3%), and eye dryness (6.3%). Strabismus Extraocular muscles adjacent to the injection site can be affected, causing ptosis, vertical deviation, spatial disorientation, double vision, or past-pointing, especially with higher doses of botulinum toxin type A. 

Twice-daily treatment option For otitis media and pharyngitis, the total daily dosage may be divided and administered every 12 hours. 

Pharyngitis, tonsiiiitis 30 mg/kg/day in single or 2 divided doses. For -hemolytic streptococcal infections, continue treatment for at least 10 days. 

Adverse reactions occurring in at least 2% of treatment-naive patients include the following abdominal pain, asthenia, diarrhea, dizziness, headache, insomnia, nausea, paresthesias, pharyngitis, somnolence, sweating, taste perversion, vomiting. 

Oral beta-lactam antibiotics such as amoxycillin, cotrimoxazole or doxycycline for 7-10 days are suitable for the treatment of bacterial sinusitis. Furuncles of the nose should be treated with an anti-staphyloccal drug for 5 days. Standard treatment for streptococcal pharyngitis consists of 10 days of penicillin. Malignant otitis externa responds to high dose quinolone therapy (e.g. ciprofloxacin 750 mg 2 t.d.) administered orally. For parapharyngeal abscess, high dose penicillin plus beta-lactamase inhibitors such as amoxycillin-clavulanic acid can be used. Duration of treatment is guided by clinical and parameters of inflammation, and abscesses often need several weeks to resolve by conservative treatment. 

E. The patient has exudative pharyngitis, presumably secondary to group A streptococcus. Antibiotic treatment is indicated to reduce the duration and severity of symptoms and to prevent acute rheumatic fever. The antibiotic of first choice is penicillin V. Other reasonable alternatives are benzathine penicillin G, erythromycin, cephalosporin, clindamycin, azithromycin, and clarithromycin. Amikacin, lome-fioxacin, metronidazole, and netilmicin are not active against group A streptococcus. 

Spectinomycin (Trobicin), an aminocyclitol antibiotic chemically related to the aminoglycosides, is occasionally used to treat uncomplicated gonococcal urethritis in patients who are allergic to (3-lactam. Treatment failures have occurred, however, when spectinomycin was used in gonococcal pharyngitis or systemic gonococcal infection. 

Although erythromycin is a well-established antibiotic, there are relatively few primary indications for its use. These indications include the treatment of Mycoplasma pneumoniae infections, eradication of Corynebacterium diphtheriae from pharyngeal carriers, the early preparox-ysmal stage of pertussis, chlamydial infections, and more recently, the treatment of Legionnaires disease, Campylobacter enteritis, and chlamydial conjunctivitis, and the prevention of secondary pneumonia in neonates. 

The toxicities of 5-fluorouracil vary with the schedule and mode of administration. Nausea is usually mild if it occurs at all. Myelosuppression is most severe after intravenous bolus administration, with leukopenia and thrombocytopenia appearing 7 to 14 days after an injection. Daily injection or continuous infusion is most likely to produce oral mucositis, pharyngitis, diarrhea, and alopecia. Skin rashes and nail discoloration have been reported, as have photosensitivity and increased skin pigmentation on sun exposure. Neurological toxicity is manifested as acute cerebellar ataxia that may occur within a few days of beginning treatment. 

It is indicated in the treatment of lower respiratory tract infection e.g. bronchitis and pneumonia, upper respiratory tract infections e.g. pharyngitis and sinusitis, infections due to chlamydia, legionella and mycoplasma, skin and soft tissue infections and eradication of H. pylori with acid suppressants. 

Benzathine penicillin and procaine penicillin G for intramuscular injection yield low but prolonged drug levels. A single intramuscular injection of benzathine penicillin, 1.2 million units, is effective treatment for 3-hemolytic streptococcal pharyngitis given intramuscularly once every 3-4 weeks, it prevents reinfection. Benzathine penicillin G, 2.4 million units intramuscularly once a week for 1-3 weeks, is effective in the treatment of syphilis. Procaine penicillin G, formerly a work horse for treating uncomplicated pneumococcal pneumonia or gonorrhea, is rarely used now because many strains are penicillin-resistant. 

Rotenone (Figure 56-1) is obtained from Derris elliptica, D mallaccensis, Lonchocarpus utilis, and L urucu. The oral ingestion of rotenone produces gastrointestinal irritation. Conjunctivitis, dermatitis, pharyngitis, and rhinitis can also occur. Treatment is symptomatic. 

Warnings Deaths due to following severe reactions have occurred after treatment with SMX Stevens-Johnson syndrome Toxic epidermal necrolysis Fulminant hepatic necrosis Agranulocytosis Aplastic anemia Other blood dyscrasias Hypersensitivity of the respiratory tract Should not be used for the treatment of streptococcal pharyngitis o c D [Pg.43]

Oral bioavailability is 57%, and tissue and intracallular penetration is generally good. Telithromycin is metabolized in the liver and eliminated by a combination of biliary and urinary routes of excretion. It is administered as a once-daily dose of 800 mg, which results in peak serum concentrations of approximately 2 g/mL. Telithromycin is indicated for treatment of respiratory tract infections, including community-acquired bacterial pneumonia, acute exacerbations of chronic bronchitis, sinusitis, and streptococcal pharyngitis. Telithromycin is a reversible inhibitor of the CYP3A4 enzyme system. 

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