Antimicrobial therapy for acute infections of otorhinolaryngological conditions, especially ear and nose diseases, were described based on the “Clinical Practice Guidelines for the Diagnosis and Management of Acute Otitis Media (AOM) in Children in Japan, 2013 update” and the “Clinical Practice Guidelines for Acute Rhinosinusitis in Children and Adults in Japan, 2010 Additional Edition.” The method to treat these infections by selecting and administering antimicrobial agents in actual practice will also be explained at the same time. In actual treatment, it is important to first determine the pathogenic bacteria and then to select and administer appropriate antibiotics according to the results. The two major causal agents of these infectious diseases are Streptococcus pneumoniae and Haemophilus influenzae. If the infectious bacteria are unknown, then antimicrobial therapy against S. pneumoniae should be administered, as it is strongly pathogenic. Although judging the therapeutic effect is important, there is a need for using a scoring system to decide whether to continue antimicrobial therapy, change the antimicrobial agent, or stop antibiotic administration by judging the effectiveness of the therapy (improvement, healing). In the treatment of acute otitis media at our hospital, good treatment results have been obtained by applying such a policy for treatment.
1. Pediatric acute rhinosinusitis shares several common features with adult acute rhinosinusitis that occurs in pregnant women as quinolone antibiotics generally cannot be used in either condition.
2. In patients with severe acute rhinosinusitis accompanied by fever, initiation of intravenous ceftriaxone infusion at the time of initial examination is one of the recommended treatment options.
3. If Haemophilus influenzae is the pathogenic bacteria, azithromycin (AZM) is one of the antibiotic options.
4. In patients with persistent rhinosinusitis, administration of the usual dosage of clarithromycin for 1–2 weeks is effective. However, if acute exacerbation is diagnosed via endoscopy, switching to high-dose penicillin or cephem antibiotics or AZM is crucial.
5. If mucopurulent nasal discharge is noted in a case of allergic rhinitis, an associated complication of paranasal sinusitis is suspected. Although careful monitoring of the patient’s course is important, antibiotics are often unnecessary.
6. For patients aged 0–2 years with acute rhinosinusitis, antibiotics are unnecessary if there is no complicating otitis media and if the general condition is good.
7. If the causative organism is anaerobic bacteria, the condition may become chronic.
Clinical findings of patients with peritonsillar abscesses were compared to the penetration of garenoxacin (GRNX) into the serum, abscesses, and palatine tonsil to determine the factors that reduce the efficacy of antibiotics toward this disease. Ten patients who underwent abscess tonsillectomies were enrolled in the study. After the oral administration of GRNX, general anesthesia was induced and samples of blood, pus from the abscess, and a part of the palatine tonsil were obtained prior to surgery for the measurement of GRNX concentration. Correlations between the concentrations of GRNX in the samples and the levels of C-reactive protein (CRP), white blood cell (WBC) count, size of the abscess and presence of ring enhancement estimated using computed tomography (CT), and the duration of the illness before surgery (in days) were examined. The data showed that the concentrations of GRNX in the abscess and serum were significantly decreased in patients with high levels of CRP (≥11 mg/dL). In patients with high WBC (≥19,000 cells/μL) counts, the concentrations were significantly decreased in the tonsil and serum. The concentrations of GRNX in the abscess were significantly lowered in patients with large abscesses (≥25 mm). The concentrations of GRNX in the abscess and tonsils were lowered when the abscess was without ring enhancement and when the illness persisted for longer than 7 days before surgery. These results indicate that severe inflammation reduces the penetration of antibiotics into the abscess and tonsils. In addition to the high levels of CRP and the high WBC count, a large abscess without ring enhancement and a short duration of illness might be indications for surgical drainage. Moreover, it is suggested that antibiotics with good tissue penetration should be used for the treatment of a peritonsillar abscess.
We herein report a case of deep neck abscess complicated with a hematoma due to a blunt injury. A 19-year-old woman, who belonged to the cheerleading team of a university, got a bruise on the left side of the neck due to a fall during practice. Since the neck swelling had not improved for one week, she consulted the orthopedics department of the general hospital. Magnetic resonance imaging (MRI) of the patient revealed crushing of the sternoclavicular muscle and a hematoma in the left deep neck. She was treated with hemostatic drugs on admission and was advised to rest. However, as the swelling in the neck worsened, she was referred to our department. She had trismus and the left side of her neck was reddish and swollen. Computed tomography (CT) detected an abscess in the deep neck area where the hematoma was present. The patient and her family preferred conservative therapy. Therefore she was initially treated with puncture drainage and antibiotics. Subsequently, bacteriological examination was performed, which revealed the pathogenic bacteria present in the abscess as Streptococcus pyogenes. The treatment was effective and she was discharged on the ninth day of hospitalization. CT was performed on the tenth day after discharge, and it confirmed that the abscess had disappeared.
We discussed the pathway of infection to the deep neck hematoma without an open wound. In general, open wounds are prone to bacterial contamination. However, it is notable that just a blunt injury may cause an abscess in the head and neck region.
We report herein a case of mumps-associated deafness in a vaccinated adult. A 34-year-old woman, who had received mumps vaccination at the age of five, presented at the Chitose City Hospital, complaining of swelling in the submandibular and subaural regions, left-sided hearing loss, and dizziness. Diagnosing the case as mumps-associated deafness, we treated her with drip infusion. While dizziness resolved with therapy, the hearing loss did not. Based on the titers of the anti-mumps IgM and IgG antibodies, we speculated that the patient was a case of primary vaccine failure.