Background: Acute sore throat (pharyngitis) accounts for 10-30% of ambulatory visits annually. Bacterial etiology, primarily Group A Streptococcus, is confirmed in only 20-34% of cases, and inappropriate antibiotic administration remains frequent, contributing to antimicrobial resistance. Community pharmacists play a key role in symptomatic management and stewardship, but real-world practices remain underexplored. Methods: A 16-item online questionnaire surveyed 629 Italian community pharmacists via professional networks, covering demographics, diagnostic tools, symptom assessment, treatment preferences, and follow-up. Responses were analyzed using descriptive statistics and interpreted within a multidisciplinary expert framework. Results: Italian community pharmacists (n = 629), predominantly mid-career and experienced individuals, prioritize targeted symptom questioning (flu-like signs (59.96%), fever (48.73%), pain intensity (49.64%)) and medical referral over formal diagnostic tools like the Centor criteria (unused in 53.66% of cases). A total of 46.74% report performing a Strep A test in fewer than 20% of patients. Topical sprays (83.33%) and lozenges (44.69%), especially containing flurbiprofen (94.19%), dominate recommendations, followed by systemic analgesics (45.79%). For mild cases, anti-inflammatory/analgesic sprays/lozenges (35.42%) and antiseptic lozenges (35.61%) dominate, while in severe cases, drugs with anti-inflammatory or analgesic effects are often preferred (72.47%). Most pharmacists request a follow-up (73.22%). Conclusions: Italian community pharmacists report a predominantly topical-first approach focused on symptomatic treatment and referral when appropriate. Diagnostic gaps and inconsistent follow-up represent actionable targets. The findings inform training outputs prioritizing simplified triage, expanded symptom checklists, spray/lozenge optimization, and 3-5-day call-backs. This work aims to promote pharmacists' antimicrobial stewardship to reduce antibiotic use while enhancing patient-centred sore throat care in Italy's pharmacy network.

The persistence of resistant pathogens in otorhinolaryngology is associated with substantial disease burden and limited effectiveness of the available antimicrobials. We aimed to provide an updated overview of nationwide antimicrobial susceptibility surveillance for major pathogens causing otorhinolaryngological infections in Japan. The 12th joint four-society survey was conducted between 2021 and 2023 in 37 institutions nationwide. Bacterial isolates from patients with acute otitis media, acute exacerbation of chronic otitis media, acute tonsillitis, and peritonsillar abscess were analyzed. Among 537 patients, 378 target bacterial isolates for antimicrobial susceptibility testing were recovered, including Haemophilus influenzae (59 isolates), Streptococcus pneumoniae (23 isolates), and anaerobes (124 isolates). The proportion of penicillin-susceptible S. pneumoniae (at a benzylpenicillin [PCG] minimum inhibitory concentration [MIC] of ≤0.06 μg/mL) was 56.5%, and penicillin-resistant S. pneumoniae (at a PCG MIC of ≥2 μg/mL) isolates were not detected. Capsular serotyping revealed that almost all S. pneumoniae isolates were non-pneumococcal conjugate vaccine 13 (PCV13) serotypes, with 10A and 35B being the most frequent; only one isolate belonged to a PCV13 serotype (19A). Notably, all 35B isolates were classified as penicillin-intermediate S. pneumoniae (PCG MIC, 0.12-1 μg/mL) and harbored pbp1a, pbp2b, and pbp2x mutations. H. influenzae showed a modest recovery of ampicillin-susceptible strains. Anaerobes from peritonsillar abscesses remained highly susceptible to β-lactam/β-lactamase inhibitor combinations and metronidazole. The 12th nationwide surveillance revealed improved antimicrobial susceptibility in major otorhinolaryngological pathogens; however, non-PCV13 serotypes such as 35B warrant continuous monitoring in the post-PCV20 era.

Acute rheumatic fever (ARF) is a delayed autoimmune complication of Group A Streptococcal (GAS) pharyngitis and remains a significant public health concern in regions such as Saudi Arabia. Timely treatment with antibiotics guided by the Centor criteria can prevent ARF, yet adherence to these recommended guidelines remains inconsistent among physicians in developing countries. This study aimed to assess the knowledge and adherence of physicians in Jeddah, Saudi Arabia, to the Centor criteria in managing streptococcal pharyngitis as a strategy to prevent ARF. A cross-sectional study was conducted among 105 physicians across various specialties. A structured questionnaire was used to evaluate their adherence and awareness. Data was analyzed using SPSS version 23.0, with chi-square tests to assess the significance (P < 0.05). Only 40% of physicians reported consistent use of the Centor criteria. Female and non-Saudi physicians demonstrated higher rates of adherence. The most compliant were consultants (42.8%), while ENT and family medicine departments demonstrated better adherence to Ministry of Health guidelines. Additionally, physicians with over 15 years of experience demonstrated significantly greater adherence than their less experienced counterparts. Significant gaps were identified in the adherence to the Centor criteria, which were influenced by professional roles and demographic factors. Promoting adherence to national guidelines and standardizing training is crucial for improving ARF prevention in Saudi Arabia.

Pharyngitis is a disorder commonly reported in ENT OPDs. The most common cause of Pharyngitis in India is Group A streptococcus, with prevalence rates of 13% in children aged 5-15%. It can also be attributed to various other bacterial, viral and fungal agents. Oral gargles are increasingly being used as a safe, effective, and non-invasive method for management. The aim of the present study was to evaluate the efficacy of Octenidine gargles in cases of Acute Pharyngitis. The present study is a prospective double blinded randomised study done in a tertiary care hospital in Sitapur, UP between 1st January, 2022 to 30th June, 2022. Patients with acute pharyngitis were randomised into two groups- Octenidine and Placebo group and subsequently, the efficacy of octenidine was studied. The octenidine gargle group reported better improvement acute pharyngitis symptoms and a significantly shorter time to symptom resolution. The study suggests that Octenidine gargles are an effective treatment option for Acute Pharyngitis, providing significant symptom relief and a shorter time to resolution when compared to warm saline gargles.

Kawasaki disease (KD) is a cryptic and self-limiting vasculitis predominantly seen in children, often posing a diagnostic challenge due to its varied clinical presentations. Among these, the emergence of deep neck infections, particularly retropharyngeal abscesses, stands out as an extremely rare manifestation. Herein, we present a case of a 10-year-old girl who was hospitalized for fever, neck pain, swollen cervical lymph nodes, and increased inflammation markers. Although anti-infective treatment was initiated, her condition remained unchanged. A cervical computed tomography scan revealed an abscess in the retropharyngeal space. Remarkably, on the third day post-admission, the patient developed symptoms synonymous with KD, such as conjunctival redness, reddened lips, and a strawberry tongue. Subsequent treatment with high-dose intravenous immunoglobulins (IVIG) and oral aspirin led to swift symptom relief, including complete abscess resolution verified by a follow-up neck magnetic resonance imaging. This unique co-presentation of KD and a retropharyngeal abscess, possibly linked to infections like Streptococcus or Staphylococcus aureus, underscores the importance of quick diagnosis and KD management, especially when conventional treatments prove ineffective.

Ear, nose and throat (ENT) or upper respiratory tract infections (URTI) are the most common infections in children and the leading causes of antibiotic prescriptions. In most cases, these infections are due to (or are triggered by) viruses and even when bacterial species are implicated, recovery is usually spontaneous. The first imperative is to refrain from prescribing antibiotics in a large number of URTIs: common cold, most cases of sore throat, laryngitis, congestive otitis, and otitis media with effusion. On the contrary, a decision to treat sore throats with antibiotics is based primarily on the positivity of the Group A Streptococcus (GAS) rapid antigen diagnostic tests. For ear infections, only (a) purulent acute otitis media in children under 2 years of age and (b) complicated or symptomatic forms of purulent acute otitis media (PAOM) in older children should be treated with antibiotics. Amoxicillin is the first-line treatment in the most cases of ambulatory ENT justifying antibiotics. Severe ENT infections (mastoiditis, epiglottitis, retro- and parapharyngeal abscesses, ethmoiditis) are therapeutic emergencies necessitating hospitalization and initial intravenous antibiotic therapy.

ObjectiveThe purpose of this study was to evaluate the diagnosis circumstances, predisposing factors, investigations, and therapeutic management of retropharyngeal and parapharyngeal abscesses.MethodsA retrospective chart review of patients diagnosed with retropharyngeal or parapharyngeal abscess from 2001 to 2021 was performed. Epidemiological characteristics, clinical signs, investigations, medical treatment, and surgical interventions were analyzed for each patient.ResultsA total of 30 patients with retropharyngeal or parapharyngeal abscess were identified. Computed tomography was performed in all cases, and magnetic resonance imaging was performed in three cases. Twelve patients had a "pure" retropharyngeal abscess, nine patients had a prestyloid abscess, one patient had a prestyloid abscess associated with a peritonsillar abscess, three patients had a retrostyloid abscess, and five patients had a prestyloid abscess associated with a retropharyngeal abscess or a retrostyloid abscess. The median long axis of the abscess was 42 cm. All patients received intravenous antibiotics for a median period of 8 days [4-30]. Seventeen patients required surgical trans-cervical drainage. Other patients underwent transoral or transnasal drainage. The pus culture revealed no growth in six cases, streptococcus (four cases), methicillin-sensitive Staphylococcus aureus (two cases), Klebsiella (two cases), Enterobacter (one case), Fungi (two cases), and Mycobacterium tuberculosis (a twelve-year-old boy). It was not documented in twelve cases. Histological examination revealed caseofollicular tuberculosis in a 53-year-old man. In 25 patients, no adverse events were observed during follow-up. Five patients had an unfavorable outcome.ConclusionWe have found an increase in the incidence of these infections in recent years. Computed tomography is the best imaging examination for the diagnosis and follow-up of retropharyngeal and parapharyngeal abscess. Early drainage and antimicrobial therapy are essential for rapid recovery and prevention of complications of these abscesses.

Introduction. Peritonsillar abscess (PTA) is a common infection which requires surgical intervention and suitable antibiotic therapy.Hypotheses/Gap Statement. Beside Streptococcus pyogenes and Fusobacterium necrophorum several other mostly anaerobic bacteria can be cultured from the properly taken pus samples of PTA, the clinical significance of which is still not fully understood.Aim. This study focused on the culture-based microbiological evaluation of PTA cases, compared to surgical intervention and empirical antibiotic management.Methodology. A retrospective analysis of PTA cases was performed between 2012 and 2019. Data about the aerobic and anaerobic culture results of the samples taken during different surgical interventions were summarized and the coverage of the empirically selected antibiotics was evaluated. The patient's history, the development of complications and the recurrence rate were also evaluated.Results. The microbiological culture results were available for 208 of 320 patients with clinically diagnosed PTA. Incision and drainage (I and D) and immediate tonsillectomy were the leading surgical interventions. Ninety-five Fusobacterium species (including 44 Fusobacterium necrophorum), 52 Actinomyces species and 47 Streptococcus pyogenes were obtained from PTA samples alone or together with polymicrobial flora. S. pyogenes (33.7 %, n=28) and F. necrophorum (22.9 %, n=19) were the dominating pathogens in the 83 monobacterial PTA samples. In >60 % of the patients polymicrobial infection was demonstrated, involving a great variety of anaerobic bacteria. In 22 out of 42 cases where intravenous cefuroxime was empirically started, the therapy should be changed to properly cover the culture-proven anaerobic flora. There were no serious complications, abscess recurrence was detected in two cases (0.96 %).Conclusion. PTAs are often polymicrobial infections including a great variety of anaerobes. Targeted antibiotic therapy, in conjunction with adequate surgical drainage eliminating the anaerobic milieu, can accelerate the healing process and radically reduce the complication and recurrence rate.

The use of antibacterial drugs has become widespread over the past 10-15 years. In this regard, there is a significant increase in antibiotic resistance in the world. Combating this problem has been one of the priorities of WHO since 2015. In light of this situation, the use of antimicrobials with no antibiotic resistance is of paramount importance. Topical antimicrobial peptides are used to treat infectious skin and mucosal diseases. The review highlights the role of the antimicrobial polypeptide thyrotricin and the complex drug doritricin in the treatment of pharyngeal pathology in adults and children according to foreign and domestic literature. The obtained data indicate the effectiveness and safety of a topical complex preparation containing thyrotricin, benzalkonium chloride and benzocaine (doritricin) as a monopreparation in the treatment of viral and bacterial tonsillopharyngitis, as well as in the complex therapy of streptococcal tonsillopharyngitis.