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Do Hospitalized Adult Patients with Acute Pharyngotonsillitis Need Empiric Antibiotics? The Impact on Antimicrobial
Chih-Wei Liang1, Mei-Cheng Hsiao2, Shin-Huei Kuo1
1Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
Insights
Hospitalized adults with acute pharyngotonsillitis are rarely studied. This 10-year surveillance found viral infections predominated, yet most received antibiotics, highlighting a need for better diagnostic tools and antimicrobial stewardship.
Area of Science:
- Infectious Diseases
- Public Health Surveillance
- Antimicrobial Stewardship
Background:
- Acute pharyngotonsillitis is a frequent reason for primary care visits, with Group A Streptococcal (GAS) pharyngitis being the most common bacterial cause requiring antibiotics.
- Overuse of antibiotics for viral pharyngotonsillitis contributes to antimicrobial resistance, yet the etiology in hospitalized adults remains understudied.
- This study addresses the knowledge gap by analyzing 10-year surveillance data of hospitalized adult patients with acute pharyngotonsillitis.
Purpose of the Study:
- To determine the etiology of acute pharyngotonsillitis in hospitalized adult patients.
- To evaluate antibiotic prescribing practices in this patient population.
- To inform strategies for improving antimicrobial stewardship in adult pharyngotonsillitis cases.
Main Methods:
- A 10-year surveillance (2011-2021) of consecutive adult patients admitted with acute pharyngotonsillitis was conducted.
- Comprehensive etiological studies were performed for all recruited patients.
- The Modified Centor Criteria and antibiotic administration rates were analyzed.
Main Results:
- A total of 117 patients had their acute pharyngotonsillitis etiology identified, with viral infections being predominant (e.g., Herpes Simplex Virus, Adenovirus, HIV, Influenza).
- Only one case of Group A Streptococcal (GAS) pharyngitis was identified.
- Despite the low prevalence of bacterial infections, 88.9% of patients received antibiotics in the emergency department and 76.9% received them during hospitalization.
Conclusions:
- Viral infections are the primary cause of acute pharyngotonsillitis in hospitalized adults, necessitating symptomatic treatment rather than antibiotics.
- Current antibiotic prescribing practices for adult pharyngotonsillitis are often inconsistent with etiological findings, indicating a need for improved antimicrobial stewardship.
- Implementing diagnostic algorithms and judicious use of criteria like the Modified Centor Criteria are recommended to guide antibiotic decisions and combat resistance.
Abstract:
Acute pharyngotonsillitis is a common reason to visit primary care providers. Group A Streptococcal (GAS) pharyngitis is the most common bacterial infection which needs antibiotic treatment. GAS accounts for only 10-15% of adult acute pharyngitis cases. The overuse of antibiotics for viral pharyngotonsillitis is common and may lead to inappropriate antimicrobial stewardship and the emergence of bacterial resistance. However, the etiology of acute pharyngotonsillitis for hospitalized adult patients is rarely studied. So, we reported the 10-year surveillance data of hospitalized adult patients with acute pharyngotonsillitis in a regional hospital in Taiwan. Every consecutive adult patient admitted with acute pharyngotonsillitis in 2011-2021 was recruited for a complete etiology study. The etiology of acute pharyngotonsillitis was identified in 117 patients. Overall, 42 herpes simplex virus cases, 26 adenovirus cases, 16 acute human immunodeficiency virus cases, 12 influenza cases, three parainfluenza cases, six Epstein-Barr virus cases, one cytomegalovirus case, four enterovirus cases, one varicella-zoster virus case, four Mycoplasma pneumoniae cases, one Chlamydophila pneumoniae case, and only one GAS case were identified. The average of the points for the Modified Centor Criteria was 1.38 (55% of patients with 0-1 points and 45% with 2-3 points). However, 88.9%of patients received antibiotics at the emergency department, and 76.9%also received antibiotics while hospitalized. Only a few patients required antibiotic treatment, while the majority of patients with viral illness needed only symptomatic treatment. However, distinguishing viral etiology from GAS pharyngitis is challenging even in the presence of tonsil exudates, high C-reactive protein, and leukocytosis. A diagnostic algorithm and the application of the Modified Centor Criteria should be considered for hospitalized adults with acute pharyngotonsillitis to improve antimicrobial stewardship.
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