The utility of nasopharyngeal culture in the management of chronic adenoiditis.

OBJECTIVES: To examine the utility of nasopharyngeal culture in the management of children with chronic adenoiditis to determine if it results in a change in antibiotic therapy. METHODS: Retrospective chart review of pediatric patients managed for chronic adenoiditis, being defined as cough, postnasal drip, and congestion for over three months with endoscopic evidence of nasopharyngeal purulence with normal anterior rhinoscopy and middle meati. Standard treatment was defined as amoxicillin clavulanate or amoxicillin clavulanate ES-600 in non-penicillin allergic patients, and cefuroxime or clarithromycin for penicillin allergic patients. Nasopharyngeal culture results and antibiotic prescriptions were reviewed to look for a change from the standard. RESULTS: Of 207 patients diagnosed with chronic adenoiditis, 198 had nasopharyngeal cultures (119 male, 79 female, mean age 3.7 years). The most common organisms isolated were Streptococcus pneumoniae sensitive to penicillin in 40 cultures (20.2%), S. pneumoniae intermediate or resistant to penicillin in 26 (13.1%), Moraxella catarrhalis in 27 (13.6%), Haemophilus influenzae in 57 (28.8%), and Staphylococcus aureus intermediate or resistant to penicillin in 26 (13.1%). 13.3% of S. aureus isolated was methicillin resistant. 103 (52.0%) children required different antibiotics from the standard, and 26 (13.1%) had no antibiotics prescribed based on a negative culture. Of the 87 children suspected to have upper airway reflux, 25 (28.7%) had negative cultures. Of the 135 patients with follow-up, 50 (37.0%) reported resolution and 50 (37.0%) reported improvement of their symptoms. CONCLUSION: Nasopharyngeal culture has significant utility in the choice of antibiotics for children with chronic adenoiditis.

Racial/ethnic differences in the prevalence of snoring and sleep disordered breathing in young children.

STUDY OBJECTIVE: To determine whether there are racial/ethnic differences in the prevalence of pediatric snoring and sleep disordered breathing (SDB). METHODS: In this cross-sectional study, parents or caretakers of 346 children, aged 2 through 6 years, attending well-child care visits at 5 general pediatric offices and clinics (3 academic, 2 private) in Brooklyn, NY completed the Sleep-Related Breathing Disorders Scale of the Pediatric Sleep Questionnaire (PSQ) along with a survey on demographics, prior treatment for SDB, and parental knowledge of pediatric SDB. The child's height and weight were recorded from the office visit. RESULTS: The prevalence of snoring was 13.9% (95% CI 10.2, 17.5) and of SDB was 9.4% (95% CI 6.3, 12.6). The odds of snoring for black children was 2.5 as great as for white children, and for Hispanic children was 2.3 as great as for white children (p = 0.031). There was a higher, non-statistically significant prevalence of abnormal PSQ scores in black and Hispanic children than white children. On multivariate analysis, only black race (OR 3.1 95% CI 1.1, 8.9) and prematurity (OR 4.4 95% CI 1.6, 12.4) were associated with snoring; male gender (OR 2.9 95% CI 1.1, 8.5) was associated with SDB. Knowledge regarding SDB was low among parents and caretakers. The degree of knowledge present was not associated with parental concern about snoring and discussion of the snoring with the child's pediatrician. CONCLUSIONS: Black race and prematurity are independent predictors of snoring. The degree of parental knowledge regarding SDB was not associated with seeking medical treatment.