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


CONCLUSIONS
Nasopharyngeal culture has significant utility in the choice of antibiotics for children with chronic adenoiditis.
State University of New York Downstate Medical Center, Department of Otolaryngology - Head and Neck Surgery, Brooklyn, NY 11203, United States.
Haidy
H
Marzouk
Behrad
B
Aynehchi
Punam
P
Thakkar
Tehila
T
Abramowitz
Ari
A
Goldsmith
D000234:Adenoids / Q000382:microbiology*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D001936:Moraxella catarrhalis / Q000302:isolation & purification; D009304:Nasopharyngitis / Q000188:drug therapy / Q000382:microbiology*; D009305:Nasopharynx / Q000382:microbiology*; D010034:Otitis Media with Effusion / Q000453:epidemiology; D010403:Penicillin Resistance; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013296:Streptococcus pneumoniae / Q000302:isolation & purification
D000900:Anti-Bacterial Agents