Differential diagnosis and effective therapy for sore throat

Sore throat is a common complaint, which can be caused by a typical viral pharyngitis, or it can be rooted in a life-threatening disease such as epiglottitis or inflammation of the cellular spaces in the throat and neck. The doctor should take a closer look at a patient with a sore throat, immediately make a differential diagnosis and prescribe adequate treatment, including surgical intervention, if necessary.The article discusses the most common causes of a sore throat, including various types of pharyngitis, paratonsillar abscess, parapharyngeal abscess, retropharyngeal abscess, epiglottitis.Viral pharyngitis has a favourable prognosis, resolves without intervention and complications, but bacterial and fungal pharyngitis have a more severe course. Streptococcal pharyngitis caused by group A в-hemolytic streptococcus holds a dominant position in bacterial etiology and requires the use of antibiotic therapy. The differential diagnosis of streptococcal pharyngitis is based on the modified Centor scores in the routine clinical practice. Antibiotic therapy for streptococcal pharyngitis includes a 10-day course of unprotected penicillins. If a patient has an allergic reaction to penicillins, it is recommended to use clindamycin or clarithromycin. The surgical intervention combined with intramuscular or intravenous antibiotic therapy is recommended for the treatment of purulent processes in the cellular spaces of the neck. These diseases can have life-threatening complications, which include neurological damage, the spread of purulent process in the mediastinum with the development of mediastinitis, laryn-geal stenosis, sepsis, necrotizing fasciitis, jugular vein thrombosis and erosion of the carotid artery. The third generation cephalosporins and protected penicillins are recommended for the treatment of epiglottitis, and respiratory fluoroquinolones are used, if a patient has a history of allergic reactions to penicillins. In severe cases with symptoms of stenosis, intubation can be performed in addition to the use of antibiotics

ACUTE SINUSITIS IN OUTPATIENT CLINICAL PRACTICE: CURRENT GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF

The article presents the main diagnostic criteria for acute sinusitis, given the differences of the clinical course of viral and bacterial sinusitis. The authors compare different recommendations on the indication of antibacterial therapy, consider starting drugs for the treatment of acute sinusitis. We discuss the possibilities and effectiveness of concomitant adjuvant therapy, including topical corticosteroids, fluids for irrigation of the nasal cavity and modern decongestants

Antihistamines in the treatment of allergic rhinitis

Allergic rhinitis is a common allergic disease that have a substantially negative impact on the patients’ quality of life. Pharmacotherapy is essential to the treatment of allergic rhinitis, including the use of antihistamines, leukotriene receptor antagonists, topical steroids, decongestants, cromones, anticholinergics and their various combinations. Antihistamines are commonly prescribed drugs to treat mild, moderate, and severe disease. The article discusses the mechanisms of action of first- and second-generation antihistamines and compares the potential side effects and drug interactions.First-generation antihistamines differ in their significant sedative and hypnotic effect, mainly due to their pronounced lipophilic properties and ability to transverse the blood–brain barrier and bind to H1-histamine receptors in the central nervous system. Due to low selectivity of the first-generation antihistamines, they may interact with other receptors and develop adverse side effects, including dry mouth, nasopharynx, more rarely pupillary dilation, increased intraocular  pressure, tachycardia, and urine retention. Bilastine is a highly selective second-generation antihistamine that has a  rapid onset and a prolonged action. This drug does not interact with the P450 cytochrome system or undergo significant metabolism in the human body, and therefore the drug has low potential for drug-drug interactions. Bilastine is excreted almost completely unchanged and therefore does not require dose adjustment in patients with renal or hepatic impairment. Bilastine demonstrated similar efficacy in seasonal allergic rhinitis compared to cetirizine and desloratadine, as well as similar efficacy and safety in long-term treatment of patients with perennial rhinitis compared to cetirizine. Bilastine is well tolerated both at standard and at supratherapeutic doses, appears to have less sedative potential than other second-generation antihistamines, and has no cardiotoxicity

Rhinitis: differential diagnosis and treatment principles

Rhinitis is inflammation of the mucous membrane inside the nose. The clinical symptoms of this disease include nasal congestion, sneezing, itching of the nose and roof of mouth, rhinorrhea, and mucus draining down the back of the throat. Both allergic and non-allergic factors can play a role in the development of rhinitis. The most commonly used classification of rhinitis includes allergic rhinitis, non-allergic rhinitis, infectious rhinitis, and its specific forms. Allergic rhinitis is classified into the intermittent or persistent types, and may also be classified as mild, moderate and severe according to the severity of symptoms. Treatment of allergic rhinitis includes elimination of contact with allergen, allergen-specific immunotherapy and pharmacotherapy, which is selected depending on the severity of the symptoms. Infectious rhinitis develops in acute viral infection, and rhinitis symptoms are present in acute and chronic rhinosinusitis. Non-allergic rhinitis comprises conditions ranging from vasomotor rhinitis and gustatory rhinitis to non-allergic rhinitis with eosinophilia syndrome. Mixed rhinitis has components of allergic and non-allergic rhinitis. In addition, there are CPAP rhinitis, occupational rhinitis, medication rhinitis, rhinitis in systemic administration of drugs, rhinitis of pregnant women, atrophic rhinitis, rhinitis in systemic diseases. The type of rhinitis is diagnosed based on the patient’s complaints, anamnesis and clinical picture, some cases require laboratory tests and CT scan of the paranasal sinuses to differentiate the diagnosis. Approaches to the treatment of rhinitis depend on its type and include elimination of allergens or provoking factors, administration of saline solutions, intranasal glucocorticosteroids, systemic antihistamines, intranasal cromones, decongestants, antibacterial drugs may be prescribed to treat infectious rhinitis. Rhinitis should be differentiated from structural abnormalities, including congenital features, acquired conditions, neoplasms, gastroesophageal reflux, nasal liquorrhea

Silver-based drugs in the treatment of inflammatory diseases of the nose

The article describes the specific antibacterial, fungicidal and antiviral mechanisms of silver-based drugs and reasons for the demand for the group of drugs in the modern healthcare. The most widely used silver-based drugs, Collargol and Protargol, their use in the treatment of inflammatory diseases of the nose in clinical practice are discussed in detail

Acute respiratory viral diseases: modern approaches to the diagnosis and treatment

Acute respiratory viral infections (ARVI) are one of the most common reasons patients seek ambulatory care. ARVIs can be caused by more than 200 strains of viruses, among which rhinoviruses remain a leading cause. The article discusses the epidemiological characteristics of ARVI and the economic damage caused by high incidence to the community. The clinical presentation of ARVI is nearly always accompanied by a combination of symptoms such as nasal discharge, nasal congestion, sore throat and cough combined with muscle pain, weakness, fatigue, headache and decreased appetite. Diagnosis of acute respiratory viral infections must be differentiated from influenza, allergic rhinitis, streptococcal tonsillitis, sinusitis and otitis media. Practicing hand hygiene is an effective way to prevent infections. The article discusses possibilities and effectiveness of concomitant adjuvant therapy, including the use of decongestants, topical glucocorticosteroids, nasal irrigation solutions, non-steroidal anti-inflammatory drugs, paracetamol and antitussive drugs. Antibacterial therapy does not have a positive effect on the course of ARVI. A clinical case describing the management of a patient with ARVI is provided

Some aspects of diagnosis and treatment of cough

The article discusses the main causes of cough in non-smoking patients, patients whose X-rays revealed no progressing lung disease, and who was not treated with ACE inhibitors for the last 2 months. The article describes the clinical manifestations and treatment principles of acute cough in acute respiratory viral infection, post-infectious cough, whooping cough, chronic cough associated with postnasal wicking, gastroesophageal reflux disease, bronchial asthma and eosinophilic bronchitis

ANTIBIOTIC THERAPY FOR ACUTE UPPER RESPIRATORY TRACT DISEASES

The article highlights the main differential diagnostic criteria for acute respiratory viral infection, acute tonsillopharyngitis and acute rhinosinusitis, and the differences in the clinical course of viral and bacterial forms of the diseases. The necessity and time frames for antibacterial therapy are discussed; medications for the initial empirical therapy of the diseases are suggested

Pharmacotherapy of allergic rhinitis

The clinical picture of allergic rhinitis includes sneezing, nasal discharge, impaired nasal breathing, and itching of the nose and roof of mouth. Depending on the duration of symptoms, allergic rhinitis is divided into intermittent and persistent forms, and depending on the severity of symptoms, it can be mild, moderate, and severe. Treatment for allergic rhinitis includes elimination of allergic contacts, allergen-specific immunotherapy, and pharmacotherapy. The choice of a treatment regimen is determined by the severity of symptoms, age of a patient and presence of concomitant diseases. The work is aimed to review the most common pharmaceuticals to treat allergic rhinitis. Saline solutions are used as monotherapy when symptoms are mild, or before use of other topical drugs to clean mucous membranes before their application. Intranasal glucocorticosteroids can be used as monotherapy, if symptoms have different levels of severity, and supplemented with other drugs, in case they are not efficient. Intranasal glucocorticosteroids do not have a systemic effect due to minimal bioavailability. The patients with moderate/severe allergic rhinitis are recommended to use them jointly with second generation antihstamines, intranasal cromones, intranasal antihistamines and leukotriene receptor antagonists. The significant side effect of antihistamines, especially of the first generation, are sedative effects on the central nervous system. The side effects of leukotriene receptor antagonists are neuropsychological disorders. Intranasal cromones have a high safety profile, which makes them popular in paediatric practice. However, the dosage regimen up to 3–4 times a day reduces patient adherence to treatment. Decongestants are not indicated as monotherapy for allergic rhinitis but can be used in combination with other drugs in short courses, taking into account the possible side effects