Complex topical treatment of patients with infectious and inflammatory pharyngeal pathology

Pharyngalgia is one of the most common complaints in both children and adults seeking medical advice. The causes of throat discomfort and pain vary and are explained by anatomo-physiological characteristics of pharynx. The lesion of pharyngeal mucosa and mucosal associated lymphoid tissue develops in 80% of acute respiratory disease cases. Detailed history taking and additional tests are required to confirm the etiology of pharyngalgia that is not related to respiratory infection and to provide appropriate treatment for the patient. Fixed topical combination with complex effectiveness established itself as a leading choice of inflammatory pharynx diseases treatment. Such treatment has the following advantages: the precise point of drug effect, minimal amount of side effects or its complete absence and risk reduction of general micro biome affection. The treatment should also be able to reach hard-to-reach areas and have good sensory properties. The purpose of topical treatment in patients with pharyngeal pathology is to relieve pain quickly, to reduce the inflammation and to prevent secondary infection of mucosa. The drug containing tyrothricin as antibiotic, benzocaine as antiseptic provides antibacterial and benzalkonium chloride as antiseptic, antiviral and analgetic effects. Not only do the early diagnosis and treatment meet the need of the patient to relieve the symptoms quickly but also have a positive impact on disease course and prevent the development of complications.

1. ESCMID Sore Throat Guideline Group, Pelucchi C., Grigoryan L., Galeone C., Esposito S. et al. Guideline for the management of acute sore throat: ESCMID Sore Throat Guideline Group. Clin Microbiol Infect. 2012;18(1):1– 28. doi: 10.1111/j.1469-0691.2012.03766.x.

2. Principi N., Bianchini S., Baggi E., Esposito S. No evidence for the effectiveness of systemic corticosteroids in acute pharyngitis, communityacquired pneumonia and acute otitis media. Eur J Clin Microbiol Infect Dis. 2013;32(2):151–160. doi: 10.1007/s10096-012-1747-y.

3. Shaikh N., Leonard E., Martin J.M. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics. 2010;126(3):557–564. doi: 10.1542/peds.2009-2648.

4. Riabova M.A. On the problem of rational antibacterial therapy of inflammatory diseases of the upper respiratory tract. Vestnik otorinolaringologii = Bulletin of Otorhinolaryngology. 2012;77(6):82–86. (In Russ.) Available at: https://www.mediasphera.ru/issues/vestnik-otorinolaringologii/2012/6/030042-46682012622.

5. Ashurst J.V., Edgerley-Gibb L. Streptococcal Pharyngitis. In: Treasure Island. (FL): StatPearls Publishing; 2020. Available at: https://www.ncbi.nlm.nih.gov/books/NBK525997/.

6. Nikiforova G.N., Svistushkin V.M. Sore throat: manifestations, diagnosis and treatment. Meditsinskiy sovet = Medical Council. 2013;(3):29–33. (In Russ.) doi: 10.21518/2079-701X-2013-3-29-33.

7. Palchun V.T. (ed.). Otorhinolaryngology: national leadership. Moscow: GEOTAR-Media; 2008. 960 p. (In Russ.)

8. Palchun V.T., Luchihin L.A., Kriykov A.I. Inflammatory diseases of the pharynx. Moscow: GEOTAR-Media; 2007. 288 p. (In Russ.)

9. Bosch A.A., Biesbroek G., Trzcinski K., Sanders E., Bogaert D. Viral and bacterial interactions in the upper respiratory tract. PLoS Pathog. 2013;9(1):32–34. doi: 10.1371/journal.ppat.1003057.

10. Gurov A.V., Yushkina M.A. Local therapy for inflammatory diseases of the pharynx. RMZH = RMJ. 2017;(11):793–796. (In Russ.) Available at: https://www.rmj.ru/articles/otorinolaringologiya/Mestnaya_terapiya_vospalitelynyh_zabolevaniy_glotki/.

11. Sloane P., Slatt L., Ebell M., Jacques L.B., Smith M.A. Essentials of Family Medicine. 5th ed. Philadelphia, Pa.: Lippincott, Williams & Wilkins; 2008.

12. Wächtler H., Chenot J.F. Die Halsschmerz-Leitlinie der Deutschen Gesellschaft für Allgemeinmedizin und Familienmedizin. HNO. 2011;59(5):480–484. doi: 10.1007/s00106-011-2263-6.

13. Cohen J.F., Bertille N., Cohen R., Chalumeau M. Rapid antigen detection test for group A streptococcus in children with pharyngitis. Cochrane Database Syst Rev. 2016;(7):CD010502. doi: 10.1002/14651858.CD010502.pub2.

14. Brook I. Treatment challenges of group a betahemolytic Streptococcal pharyngo-tonsillitis. Int Arch Otorhinolaryngol. 2017;21(3):286–296. doi: 10.1055/s-0036-1584294.

15. Kozlov S.N., Strachunsky L.S. Pharmacotherapy of acute tonsillopharyngitis in outpatient setting: results of a multicenter pharmacoepidemiological study. Terapevticheskiiy arhiv = Therapeutic archive. 2004;76(5):45–51. (In Russ.) Available at: https://elibrary.ru/item.asp?id=17090478.

16. Linder J.A., Bates D.W., Lee G.M., Finkelstein J.A. Antibiotic treatment of children with sore throat. JAMA. 2005;294(18):2315–2322. doi: 10.1001/jama.294.18.2315.

17. Hsieh T.H., Chen P.Y., Huang F.L., Wang J.D., Wang L.C., Lin H.K. et al. Are empiric antibiotics for acute exudative tonsillitis needed in children? J Microbiol Immunol Infect. 2011;44(5):328–332. doi: 10.1016/j.jmii.2010.08.009.

18. Holm K., Bank S., Nielsen H., Kristensen L.H., Prag J., Jensen A. The role of Fusobacterium necrophorum in pharyngotonsillitis – A review. Anaerobe. 2016;42:89–97. doi: 10.1016/j.jmii.2010.08.009.

19. Brook I. The role of anaerobic bacteria in tonsillitis. Int J Pediatr Otorhinolaryngol. 2005;9(1):9–19. doi: 10.1016/j.ijporl.2004.08.007.

20. Kosenko I.M. A modern immunocorrection strategy for tonsillitis and pharyngitis in children. Voprosy sovremennoii pediatrii = Current Pediatrics. 2007;6(4):74–79. (In Russ.) Available at: https://vsp.spr-journal.ru/jour/article/view/1254.

21. Uchaykin V.F. Infectious Disease Guide. Moscow: GEOTAR-Med; 2001. 824 p. (In Russ.)

22. Chelenkova I.N., Uteshev D.B., Bunyatyan N.D. Acute and chronic inflammatory diseases of the upper respiratory tract. RMZH = RMJ. 2010;(30):1878–1882. (In Russ.) Available at: https://www.rmj.ru/articles/pulmonologiya/Ostrye_i_hronicheskie_vospalitelynye_zabolevaniya_verhnih_dyhatelynyh_putey/.

23. Voinov V.A. Atlas on pathophysiology. 2nd ed., revised and supplemented. Moscow: Medical information agency; 2007. (In Russ.)

24. Polyakov D.P., Karneeva O.V., Ryazantsev S.V., Garashchenko T.I., Gurov A.V., Kazanova A.V., Maksimova E.A. Clinical recommendations: acute tonsillopharyngitis, KR306. Ministry of Health of the Russian Federation, National Medical Association of Otolaryngologists; 2016. (In Russ.) Available at: http://cr.rosminzdrav.ru/#!/recomend/17.

25. Steinberg D.A., Hurst M.A., Fujii C.A., Kung A.H., Ho J.F., Cheng F.C., Loury D.J., Fiddes J.C. Protegrin-1: a broad-spectrum, rapidly microbicidal peptide with in vivo activity. Antimicrob Agents Chemother. 1997;41(8):1738–1742. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC163996/.

26. Kondejewski L.H., Farmer S.W., Wishart D.S., Hancock R.E., Hodges R.S. Gramicidin S is active against both gram-positive and gram-negative bacteria. Int J Pept Protein Res. 1996;47(6):460–466. doi: 10.1111/j.1399-3011.1996.tb01096.x.

27. Hancock R.E. Cationic peptides: effectors in innate immunity and novel antimicrobials. Lancet Infect Dis. 2001;1(3):156–164. doi: 10.1016/s14733099(01)00092-5.

28. Eberhardt R., Maier-Bosse I., Schlauch W. Halsschmerzen bei akuter Pharyngitis. Deutsche Apotheker Zeitung. 2004;144(7):753–754. doi: 10.1111/j.1399-3011.1996.tb01096.x.

29. Scholten T., Pautler M., Kober G. Dorithricin bei akuter Pharyngitis. Deutsche Apotheker Zeitung. 2005;145(1):81–82. doi: 10.1111/ijcp.13272.

30. Palm J., Fuchs K., Stammer H., Schumacher-Stimpfl A., Milde J. DoriPha investigators. Efficacy and safety of a triple active sore throat lozenge in the treatment of patients with acute pharyngitis: Results of a multi-centre, randomised, placebo-controlled, double-blind, parallel-group trial (DoriPha). Int J Clin Pract. 2018;72(12):13272. doi: 10.1111/ijcp.13272.

31. Galkina L.A. Modern approaches to the treatment of acute purulent tonsillitis in children. Detskay otorinolaringologiya = Children’s Otorhinolaryngology. 2019;(3):24–28. (In Russ.) Available at: https://elibrary.ru/item.asp?id=41104405.