Page 42 - GALENIKA MEDICAL JOURNAL

Zaključak

Nije svaki bol u grlu prouzrokovan infektivnim uzročnikom, pa će lečenje osnovnog faktora (lošeg
disanja na nos, laringofaringealnog refluksa, uklanjanja potencijalnih štetnih faktora) dovesti i do
adekvatnog terapijskog odgovora.

Akutni tonzilofaringitis najčešće predstavlja virusnu, ređe bakterijsku infekciju, ali ih je klinički često
teško razlikovati. Diferencijalna dijagnoza virusnog u odnosu na bakterijski tonzilofaringitis izuzetno
je važna, jer, sa jedne strane, neracionalna primena antibiotika dovodi do neželjenih dejstava ovih

lekova i razvoja rezistencije bakterija na antibiotike, dok sa druge strane, izostanak adekvatne terapije
može dovesti do razvoja komplikacija opasnih po život. U diferencijalnoj dijagnozi virusne u odnosu
na infekciju SGA, kao najčešćim bakterijskim uzročnikom tonzilofaringitisa, zadovoljavajuću tačnost
pruža kombinacija kliničkog skora i brzog testa na SGA. Virusne infekcije leče se simptomatski, dok su
kod infekcija SGA lekovi izbora penicilinski preparati. Lečenje se može kombinovati sa jednokratnom
primenom malih doza kortikosteroida čime se ubrzava klinički oporavak.

Abstract

Acute tonsillitis and pharyngitis are common diseases in clinical practice. Uncritical use of antibiotics has led to an
increasing problem of antibiotic resistance. On the other hand, it is of great importance to correctly diagnose and timely
treat bacterial tonsillopharyngitis in order to prevent complications. The aim of this paper was to review current guides
and published papers in the professional literature related to diagnostics and therapy in children and adults, with the
aim of their greater implementation in clinical practice.

Acute tonsillopharyngitis is far more often – a viral infection, less often - a bacterial infection. In the differential
diagnosis of these entities, the combination of clinical scores and rapid test for group A streptococcus is of the greatest
importance. According to individual clinical assessment, microbiological analysis of throat swabs and laboratory blood
tests may also be important. Viral tonsillopharyngitis is treated symptomatically. In the treatment of bacterial infections,
penicillin preparations are the drug of choice. Treatment can be combined with a single dose of orally administered
corticosteroid. The basic principle of treatment of acute tonsillopharyngitis must be a measure of clinical parameters,
available diagnostics, general condition of the patient and his comorbidities.

Keywords: acute tonsillitis, acute pharyngitis, guideline, systematic review

Literatura 6. Klug TE. Peritonsillar abscess: clinical aspects of microbiology,
risk factors, and the association with parapharyngeal
abscess. Dan Med J. 2017 Mar;64(3):B5333.
1. Novi nacionalni vodič za racionalnu upotrebu antibiotika. 7. NICE guideline.Sore throat (acute): antimicrobial prescribing.
Ministarstvo zdravlja Republike Srbije, 2018. (Serbian) Available from: https://www.nice.org.uk/guidance/ng84
Available from: https://www.zdravlje.gov.rs/tekst/335899/novi-
nacionalni-vodic-za-racionalnu-upotrebu-antibiotika-.php 8. NICE guidance. Rapid tests for group A streptococcal
2. Mustafa Z, Ghaffari M. Diagnostic Methods, Clinical Guidelines, infections in people with a sore throat. Available
from: https://www.nice.org.uk/guidance/dg38
and Antibiotic Treatment for Group A Streptococcal Pharyngitis: A
Narrative Review. Front Cell Infect Microbiol. 2020 Oct 15;10:563627. 9. Luo R, Sickler J, Vahidnia F, Lee YC, Frogner B, Thompson M. Diagnosis
3. Sykes EA, Wu V, Beyea MM, Simpson MTW, Beyea JA. and Management of Group a Streptococcal Pharyngitis in the
Pharyngitis: Approach to diagnosis and treatment. United States, 2011-2015. BMC Infect Dis. 2019 Feb 26;19(1):193.
Can Fam Physician. 2020 Apr;66(4):251-7. 10. Karthikeyan G, Guilherme L. Acute rheumatic fever.
4. Center for Disease Control and Prevention. Pharyngitis Lancet. 2018 Jul 14;392(10142):161-74.
(Strep Throat). Available from: https://www.cdc.gov/ 11. Center for Disease Control and Prevention. Antibiotic
groupastrep/diseases-hcp/strep-throat.html Prescribing and Use. Treatment Recommendations. Available
5. Windfuhr JP, Toepfner N, Steffen G, Waldfahrer F, Berner R. Clinical from: https://www.cdc.gov/antibiotic-use/clinicians/adult-
treatment-rec.html?CDC_AA_refVal=https%3A%2F%2Fwww.
practice guideline: tonsillitis I. Diagnostics and nonsurgical cdc.gov%2Fantibiotic-use%2Fcommunity%2Ffor-
management. Eur Arch Otorhinolaryngol. 2016 Apr;273(4):973-87.
hcp%2Foutpatient-hcp%2Fadult-treatment-rec.html
42 DOI: 10.5937/Galmed2202037S