Clinical predictors and antibiotics sensitivity of bacterial pathogens of pharyngotonsillitis among children aged 1-17 years in a Tertiary Hospital, Abakaliki, Southeast, Nigeria.

Abstract

Introduction: clinical presentations that possibly predict bacterial pharyngotonsillitis are invaluable in early institution of care, so as to reduce morbidity from the disease. This is augmented by knowledge of antibiotic sensitivity pattern of the commonly isolated pathogens in the locality. The study was aimed at determining the relationship between clinical presentations and laboratory diagnosis of bacterial pharyngotonsillitis and to determine the antibiotics susceptibility pattern of the isolates.

Methods: a hospital-based descriptive cross-sectional study was carried out over period of seven (7) months from 3^rd November, 2020, to 28^th May, 2021. The participants were consecutively recruited. Structured questionnaire was used to obtain information on socio-demographics of the participants. Throat swabs were taken from participants and sent to Medical Microbiology Research Laboratory of Alex Ekwueme Federal University Teaching Hospital, Abakaliki for microscopy, culture and sensitivity. Descriptive statistical analysis was used to determine frequencies and percentages. Univariate analysis was used to find any association between dependent variable and independent variables.

Results: of the 150 participants that were recruited, 58.7% were males, giving a male-to-female ratio of 1.4: 1. The median age of participants was 5.0 years with an interquartile range of 3-8 years. Bacterial isolates were noted in 54 (36%). There was an overlap between the clinical features seen in participants with positive bacteria culture and those seen in negative (sterile) culture. The positive predictive values using clinical features to predict pharyngotonsillitis of bacterial origin were low. Most of the isolated organisms were more susceptible to cephalosporins (ceftriaxone and cefuroxime) than the penicillin (penicillin V and amoxicillin clavulanate).

Conclusion: an overlap observed between the clinical presentations of the participants with positive throat culture and those without in this study makes clinical features unreliable in predicting pharyngotonsillitis of bacterial origin. Hence routine throat swab for bacteriology culture should be done for all children presenting with features suggestive of pharyngotonsillitis before commencement of antibiotics. However, where such services are not readily available, the use of cephalosporins empirically is recommended.