Prescribing antibiotics for sore throat: adherence to guidelines in patients admitted to hospital.

AIM: We prospectively studied patients referred to secondary care with acute tonsillitis, peritonsillar cellulitis and quinsy (peritonsillar abscess) to see if recommended treatment guidelines were being followed and whether antibiotic resistance was contributing to admission. STUDY DESIGN: Prospective observational study in a university teaching hospital of 90 consecutive patients admitted to secondary care over an 18 month period with acute tonsillitis, peritonsillar cellulitis or quinsy were studied. The geographical distribution by postcode, pre-admission history and treatment of each patient was recorded. The patients' general practitioners (GPs) were questioned about the patients' history, their use of antibiotics and prescribing guidelines and a patient questionnaire was completed. The result of hospital admission including throat swabs and blood cultures were recorded together with their treatment and outcome. RESULTS: 58% (n = 28) of patients who were prescribed antibiotics before admission received an inadequate dose or inappropriate antibiotic. Only 56% (n = 45) of GPs said they used guidelines for the treatment of acute sore throat. In 34 cases an organism was isolated, with 33 (97%) being sensitive to penicillin. No resistant organisms were isolated. Hospital doctors prescribed antibiotics contrary to guidelines in 39% (n = 35) of cases. CONCLUSIONS: Antibiotic resistance was not demonstrated in this study. Adherence to guidelines for prescribing antibiotics in patients with features of group A beta-haemolytic streptococcal sore throat is poor. Information support may help to improve prescribing.

Prevalence of facial pain in 108 consecutive patients with paranasal mucopurulent discharge at endoscopy.

We undertook a prospective observational study of 108 consecutive patients with endoscopic paranasal mucopurulent secretions. Only 31 patients (29 per cent) had facial pain. In 20 (65 per cent), the endoscopic site of purulent secretions corresponded to the site of pain. In those with facial pain, 74 per cent had nasal obstruction, 68 per cent had objective hyposmia and 84 per cent had mucopurulent rhinorrhoea. In the 31 patients with facial pain, 19 (61 per cent) became symptom free following medical treatment. The remaining 12 patients underwent surgery and their symptoms resolved, except for one patient with a tension-type headache and another with pain of unknown cause. Most patients with purulent secretions from the paranasal sinuses do not have facial pain; therefore, chronic rhinosinusitis is not synonymous with pain. Patients with sinogenic facial pain usually have endoscopic findings that correlate with the site of pain, and the majority also have other nasal symptoms. Chronic infective rhinosinusitis usually responds to medical therapy, and the remainder resolve with surgery.

A study of intranasal distribution of azelastine hydrochloride aqueous nasal spray with different spray techniques.

Topical aqueous nasal sprays are widely used in treating patients with a variety of nasal diseases. Previous studies have suggested that drug delivery to the ciliated mucosa is generally suboptimal. Little is known about the effects of nasal spray delivery technique on intranasal distribution and efficacy of topical nasal drugs. We assessed the intranasal distribution of a nasal spray with two commonly used techniques using azelastine hydrochloride labelled with fluorescein. After spraying, the nasal cavity was photographed endoscopically in two standardized positions, one showing the anterior portion in the region of the nasal valve and one the area of the middle meatus. The photographs were computer analysed to identify the proportion of coverage of fluorescein in each image field. The majority of drug was distributed anteriorly with poor coverage posterior to the nasal valve area. This was the case with both of the positions tested.

An evaluation of the best head position for instillation of steroid nose drops.

Steroid nose drops are used frequently to treat rhinosinusitis and nasal polyposis. The middle meatal area is of key importance in the pathophysiology of these conditions. This study assesses which of three head positions commonly used to instil nose drops resulted in the highest coverage of this area. Discomfort levels were also studied using a visual analogue scale for each position. Five volunteers were studied in: (i) head back (HB); (ii) head forward and down (HFD); and (iii) lying head back (LHB) positions. Betamethasone nose drops, dyed with fluorescein, were instilled into each nostril and the distribution was studied endoscopically. The middle meatus area distribution was highest in the LHB position (55.51%), followed by HFD (31.55%) and HB (6.87%) positions. Comparison of distribution between HB and LHB (P = 0.002) and between HB and HFD (P = 0.045) was statistically significant. The HFD position was most uncomfortable (mean discomfort score 8.8) whereas the HB (2.4) and LHB (2.6) were similar. The LHB would, therefore, appear to be the most suitable position for instillation of steroid nose drops.

Ear deformity in children following high ear-piercing: current practice, consent issues and legislation.

In this presentation we examine the practice of high ear-piercing in children, the issue of informed consent and current legislation. We sampled current practice and consent policy by visiting nine establishments in Sheffield providing this service. There were two high street department stores, two fashion accessory outlets and five body-piercing studios. Enquiries were made as to the technique used, knowledge of complications, customer counselling and consent policy. A photograph of an ear with a cosmetic deformity following high ear-piercing was shown and awareness of this possible outcome was noted. Two ear-piercing techniques were identified, either a spring-loaded gun firing a blunt stud or the use of a body-piercing needle. The fashion accessory outlets were prepared to pierce any part of the ear using a spring-loaded gun in children under 16 years of age. There was a general lack of knowledge about possible serious complications. Two of the body piercers would not perform high ear-piercing on clients under the age of 16 years. The body piercers use a disposable needle and were of the opinion that using a spring-loaded gun shatters the cartilage and increases the risk of infection. The best technique is open to debate and it may be that the perceived unsavoury environment of the body-piercing studio represents a safer option than the more respectable or cheaper alternatives. The practice of body piercing in the UK remains uncontrolled.