ISKRA GUIDELINES ON SORE THROAT: DIAGNOSTIC AND THERAPEUTIC APPROACH – CROATIAN NATIONAL GUIDELINES
Autori:
Arjana Tambić Andrašević, Tomislav Baudoin, Dalibor Vukelić, Suzana Mimica Matanović, Danijela Bejuk, Diana Puževski, Maja Abram, Goran Tešović, Zdravko Grgurev, Gordana Tomac, Irina Pristaš
Sažetak
Sažetak. Upala grla je najčešće uzrokovana virusima, a od bakterijskih uzročnika najvažniji je beta-hemolitički streptokok grupe A (BHS-A). Svrha ovih smjernica je navesti optimalnu terapiju streptokokne upale grla i razumne indikacije za tonzilektomiju, ali i preporučiti kako razlučiti streptokoknu infekciju, pri kojoj je primjena antibiotika opravdana, od brojnih drugih grlobolja gdje primjena antibiotika neće imati bitan utjecaj na tijek bolesti, ali će pridonijeti razvoju rezistencije bakterija na antibiotike. Smjernice su nastale na inicijativu Interdisciplinarne sekcije za kontrolu rezistencije na antibiotike (ISKRA) Ministarstva zdravstva i socijalne skrbi Republike Hrvatske i nastale su u skladu s principima AGREE (engl. Appraisal of Guidelines for Research and Evaluation) metodologije što podrazumijeva da su ove smjernice rezultat konsenzusa svih zainteresiranih stručnih društava i institucija. U dijagnostici streptokokne upale grla Radna grupa preporučuje procjenu kliničke slike prema Centorovim kriterijima te za pacijente s 0–1 bodova po Centoru ne preporučuje antibiotsku terapiju niti bakteriološko testiranje, a za pacijente sa zbrojem bodova od 2 do 4 po Centoru preporučuje učiniti bakteriološko testiranje (brzi test ili kultura) te propisati antibiotsku terapiju u slučaju pozitivnoga bakteriološkog testa. Prvi lijek izbora u liječenju streptokoknog tonzilofaringitisa je penicilin primijenjen peroralno tijekom 10 dana (penicilin V) ili u slučaju slabe suradljivosti pacijenta jednokratno parenteralno (benzatin penicilin G). Drugi antibiotici (makrolidi, klindamicin, cefalosporini, ko-amoksiklav) primjenjuju se iznimno u slučajevima preosjetjivosti na penicilin ili kod rekurirajućih infekcija. Tonzilektomija je prihvaćena kirurška metoda kojom se smanjuje broj grlobolja u djece, ali samo ako se poštuju indikacije za taj zahvat. Apsolutne indikacije uključuju pet ili više streptokoknih infekcija na godinu, pojavu komplikacija tonzilitisa, trajnu opstrukciju dišnih putova, sindrom opstruktivne apneje u spavanju te suspektni malignom tonzile. Relativ¬ne indikacije uključuju kronični tonzilitis i poremećaje okluzije.
Summary
Summary. Sore throat is most commonly caused by viruses, but when caused by bacteria, the most important is group A streptococcus (GAS). The aim of these guidelines is to determine optimal treatment for streptococcal sore throat and reasonable indications for tonsillectomy, as well as recommend how to differentiate streptococcal infection for which antibiotics are justified, from numerous other sore throats where antibiotics wonžt have a significant effect on disease course, but might contribute to bacterial resistance to antibiotics. The development of the guidelines was initiated by the Interdisciplinary Section for Antibiotic Resistance Control (ISKRA) of the Croatian Ministry of Health and Social Welfare in accordance with the principles of AGREE (Appraisal of Guidelines for Research and Evaluation) methodology which means that the guidelines are the result of consensus between all interested professional societies and institutions. For streptococcal sore throat diagnostics, the Working Group recommends evaluation of clinical presentation according to Centor criteria and for patients with Centor score 0–1, antibiotic therapy is not recommended nor bacteriological testing, while for patients with Centor score 2–4 bacteriological testing is recommended (rapid test or culture) as well as antibiotic therapy in case of positive result. The drug of choice for the treatment of streptococcal tonsillopharyngitis is oral penicillin taken for ten days (penicillin V) or in case of poor patient compliance benzathine penicillin G can be administered parenterally in a single dose. Other antibiotics (macrolides, clindamycin, cephalosporins, co-amoxiclav) are administered only in case of hypersen-sitivity to penicillin or in recurrent infections. Tonsillectomy is a widely accepted surgical procedure that decreases the number of sore throats in children and should be performed only if indications for this procedure are established. Absolute indications include five or more streptococcal infections per year, tonsillitis complications, permanent respiratory tract obstruction, obstructive sleep apnea syndrome and suspected tonsillar malignancy. Relative indications include chronic tonsillitis and occlusion disturbances.
