An Investigation of the Frequency of Upper Respiratory Tract Infection Pathogens and their Antibiotic Patterns in Tonsils and Adenoids of Adenotonsillectomy Patients.

BACKGROUND

We aimed to investigate the potentially pathogenic bacteria of upper respiratory tract infections (URTIs) and their susceptibilities to different antibiotics.

METHODS

Two-hundred adenoid and tonsil specimens from 100 patients who had undergone adenotonsillectomy were obtained and analyzed bacteriologically. Identification of the pathogens was made by conventional or commercial identification systems and antibiotic susceptibility tests were carried out by disk diffusion method.

RESULTS

A total of 274 pathogens were recovered from 81% specimens of 73% of the patients. Haemophilus influenzae (31.8%) was the most prevalent pathogen, followed by Staphylococcus aureus (17.2%), Group A beta hemolytic Streptococci, GABHS (12.0%), Moraxella catarrhalis (7.7%), Streptococcus pneumoniae (7.3%), and nine other bacterial species (24.0%). Penicillins (penicillin, ampicillin) had 100% activity against GABHS followed by 96.5% in H. influenzae, 45% in S. pneumoniae, and 0% in S. aureus strains. The efficacy of beta-lactamase inhibitor antibiotics (ampicillin/sulbactam, amoxycillin/clavulanic acid) were similar to those of penicillins but had superior activity (89.4%) against S. aureus strains. Cefotaxime had high activity (100%) against GABHS and H. influenzae followed by S. aureus (89.4%). Cotrimoxazole was also active in S. aureus (97.8%) and H. influenzae (83.9%) but revealed intermediate activity (45%) in S. penumoniae and was not efficient (0%) in GABHS. Macrolids (erythromycin, clindamycin) were very efficient (100%) in GABHS followed by S. aureus (95.7%) and had intermediate activity (50%) in S. pneumoniae. Levofloxacin, telithromycin, and vancomycin had 100% activity against S. pneumoniae strains.

CONCLUSIONS

Our finding have shown that H. influenzae was the most prevalent pathogen followed by S. aureus, GABHS, M. catarrhalis, and S. pneumoniae and that there was no unique antibiotic to combat all prevalent pathogens, but penicillins could be the choice in GABHS and H. influenzae; beta-lactamase inhibitors and cefotaxime for GABHS, H. influenzae, and S. aureus; macrolids in GABHS and S. aureus; cotrimoxazole in H. influenzae and S. aureus; and levofloxacin and telithromycin in the treatment of S. penumoniae related URTIs.