Study of drug sensitivity profile of patients with throat infections in lower Himalayan region

INTRODUCTION

An infectious-related pharyngitis is just one of the many possible causes of sore throat in adults. Pharyngitis in adults is caused by a bacterial infection in approximately 5% to 10% of patients. This is different than in children, in whom bacterial pharyngitis accounts for 30% to 40% of cases.¹ Approximately 75% of adults presenting with a sore throat are prescribed antibiotics for a presumed bacterial pharyngitis even though this practice will only help a minority of patients. Pharyngitis may occur in different grades of severity. Milder infections present with discomfort in the throat, some malaise and low grade fever. Pharynx in these cases is congested but there is no lymphadenopathy. Moderate and severe infections present with pain in throat, dysphagia, headache, malaise and high fever. Pharynx in these cases shows erythema, exudate and enlargement of tonsils and lymphoid follicles on the posterior pharyngeal wall.²

Aims and objectives

The aims and objectives of the study were to study the drug sensitivity or resistance profile of patients with throat infections.

METHODS

The study was conducted as a prospective study in the department of otorhinolaryngology and head and neck surgery, Regional Hospital Bilaspur, Himachal Pradesh, India from June 2019 to December 2019. During this period 100 patients with throat infections were included in the study.

Study population

Study group include general population presenting in Outpatient Department of Regional Hospital Bilaspur fulfilling inclusion and exclusion criteria in both sexes as given below.

Inclusion criteria

Inclusion criteria were patients with complaints of throat pain, throat irritation, throat itching, foreign body sensation throat; patients giving consent for study; patients below age 100 years; patients above the age of 1 year.

Exclusion criteria

Exclusion criteria were age >100 years or <1 year, patients without throat complaints.

The enrolled patients are explained about the complete study procedure in their language. The procedure were detailed history obtained from study participants regarding; clinical examination of patient is done including general physical examination and systemic examination for assessing the general condition of participants, a thorough ENT examination is done including throat examination, ear examination, nasal examination; throat swab samples collected through a sterile culture sensitivity tube and sent to microbiological lab in the Regional Hospital Bilaspur (SRL diagnostics) and culture sensitivity reports collected from the patients during follow up visits.

Statistical analysis

Data were entered in Microsoft Excel sheet. The continuous variables were presented using mean or median. For categorical variables proportions were used. The statistical analysis was done using Epi Info v7 software.

RESULTS

This prospective study aimed at studying the infective profile of patients with throat infections and to study the drug sensitivity profile in these patients in lower Himalayan population. A total of 100 patients of either sex with complaint of throat ache were included in the study and their demographic profile, clinical presentation studied followed by microbiological culture and sensitivity testing of throat swab samples. Thirteen (13%) patients were aged 0 to 20 years, twenty eight (28%) patients were in the age group 21 to 40 years, thirty six (36%) patients were in the age group 41 to 60 years, nineteen (19%) patients were in the age group 61 to 80 years and four (04%) patients were in the age group 81 to 100 years.

Thirty four (34%) patients were female adults, fifty six (56%) patients were male adults, six (06%) patients were male child, four (04%) patients were female child. Sixty two (62%) patients were diagnosed as acute pharyngitis, thirty eight (38%) patients were diagnosed as chronic pharyngitis.

Acinetobacter baumani was present in three (03%) patients, Aeromonas hydrophilla in two (02%) patient, Citrobacter koseri in one (01%) patients, Citrobacter youngae in two (02%) patient, Enterobacter aerogenes in four (04%) patients, Enterobacter cloacae was present in four (04%) patient, Enterobacter faecalis in one (01%) patient, Escherichia coli in nine (09%) patients, Klebsiella pneumoniae in fifteen (15%) patients, Klebsiella oxytoca in three (03%) patients, Morgenella morganii in two (02%) patient, Pseudomonas putida in two (02%) patients, Pseudomonas aeurginosa in twenty one (21%) patients, Staphylococcus aureus in sixteen (16%) patients, Staphylococcus epidermidis in one (01%) patient, Serratia marcescenes in one (01%) patients, Roultella ornitholytica in one (01%) patient, and no growth seen in twelve (12%) patients.

Gram positive organisms are detected in eighteen (18%), Gram negative organisms detected in seventy (70%), and no organism detected in twelve (12%) of the throat swab samples.

Benzyl penicillin or ampicillin was found to be sensitive in none of patients and resistant in 14 out of 14 (100%) patients. Tetracyclin was found to be sensitive in 13/14 (92.85%) patients and resistant in 01 out of 14 (7.15%) patients. Gentamycin was found to be sensitive in 12/15 (80%) patients, resistant in 2 out of 15 (13.33%) patients and intermediate sensitive in 1 out of 15 (6.66%) patients. Clindamycin was found to be sensitive in 3 out of 13 (23.07%) patients and resistant in 10 out of 13(76.92%) patients. Trimethoprim or sulphamethoxazole was found to be sensitive in 6 out of 15 (40%) patients and resistant in 9 out of 15 (60%) patients. Ciprofloxacin or levofloxacin was found to be sensitive in 2 out of 15 (13.33%) patients and resistant in 13 out of 15 (86.66%) patients. Linezolid was found to be sensitive in all 14 out of 14 (100%) patients throat swab samples tested.

Ampicillin was found to be resistant in 19 out of 22 (86.36%) and intermediate sensitive in 3 out of 22(13.63%). Pipracillin or tazobactum was found to be sensitive in 57 out of 61 (93.44%) patients, resistant in 02 out of 61 (3.27%) patients and intermediate sensitive in 02 out of 61 (3.27%) patients. Cefoperazone was found to be sensitive in 59 out of 66(89.39%) patients, resistant in 05 out of 66 (7.57%) patients and intermediate sensitive in 02 out of 66 (3.03%) patients. Amikacin was found sensitive in all the 65 out of 65 (100%) patients tested. Gentamycin was found to be sensitive in 65 out of 67 (97.01%) patients, resistant in 1 out of 67 (1.49%) patients and intermediate sensitive in 01 out of 67 (1.49%). Imipenem was found to be sensitive in 66 out of 68 (97.05%) patients, resistant in 1 out of 68 (1.47%) patients and intermediate in 01 out of 68 (1.47%) patients. Cefepime was found to be sensitive in 54 out of 57 (94.73%) patients and resistant in 3 out of 57 (5.26%) patients. Ciprofloxacin was found to be sensitive in 64 out of 68 (94.11%) patients and resistant in 04 out of 68 (5.88%) patients. Trimethoprim or sulpha-methoxazole was found to be sensitive in 35 out of 39(89.74%) patients and resistant in 04 out of 39 (10.29%) patients. Amoxyclav was found to be sensitive in 18 out of 22 (42.85%), resistant in 18 out of 42 (42.85%) patients and intermediate sensitive in 06 out of 42 (14.28%) patients.

DISCUSSION

Acute pharyngitis is very common and occurs due to varied aetiological factors like viral, bacterial, fungal or others. Viral causes are more common. Acute streptococcal pharyngitis (due to group A beta haemolytic streptococci) has received more importance because of its aetiology in rheumatic fever and post-streptococcal glomerulonephritis. Chronic pharyngitis develops when infection of pharynx persists for more than 4 weeks. Respiratory tract infection³ is considered as one of the major public health problems and a leading cause of morbidity & mortality in many developing countries. Streptococcus pyogenes is one of the commonest bacterial pathogens that causes acute pharyngitis among school-aged children living in lower socio-economic conditions. These Gram positive cocci are distributed worldwide and have been associated with a variety of sequelae such as impetigo, otitis media, necrotizing fasciitis, glomerulonephritis, acute rheumatic fever or rheumatic heart disease.⁴

Antibiotic resistance is rising to dangerously high levels in all parts of the world. New resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases. Throat infections are one of the major causes of antibiotic resistance as over the counter use of medications in patients with ear discharge is prevalent in the area of study. In our study gram positive (18%) organisms Benzyl penicillin or ampicillin was found to be sensitive in none of patients and resistant in 14 out of 14 (100%) patients. Tetracyclin was found to be sensitive in 13 out of 14 (92.85%) patients and resistant in 01 out of 14 (7.15%) patients. Gentamycin was found to be sensitive in 12 out of 15 (80%) patients, resistant in 2 out of 15 (13.33%) patients and intermediate sensitive in 1 out of 15 (6.66%) patients. Clindamycin was found to be sensitive in 3/13 (23.07%) patients and resistant in 10 out of 13 (76.92%) patients. Trimethoprim or sulphamethoxazole was found to be sensitive in 6 out of 15 (40%) patients and resistant in 9 out of 15 (60%) patients. Ciprofloxacin or levofloxacin was found to be sensitive in 2 out of 15 (13.33%) patients and resistant in 13 out of 15 (86.66%) patients. Linezolid was found to be sensitive in all 14 out of 14 (100%) patients throat swab samples tested. Moirangthem et al studied bacteriological analysis and its antibiogram profile of pharyngitis cases from the patients attending referral hospital Sikkim India and found that 3 isolates of S. aureus were sensitive to penicillin, 1 isolate was moderately sensitive and 17 isolates were resistant.⁵ 12 strains of S. aureus were sensitive to methicillin. Methicillin resistant was seen in 9 strains of Staph. aureus. The strains of S. pyogenes isolated were either moderately sensitive or resistant to the used antibiotics, it was not sensitive to any of the used antibiotics. It was moderately sensitive to amoxyclave, clarithromycin, erythromycin and resistant to clindamycin and cefuroxime. 100% strains of P. aeruginosa were resistant to ciprofloxacin, gentamycin, piperacillin, ticarcillin, tobramycin and the strains were sensitive only to Imipenem (100%). Further 100% strains of Proteus sp. were sensitive to cefuroxime, azithromycin, amoxicillin and cephalexin. These results were slightly different from our study.

In our study Gram positive (70%) organisms shows Ampicillin was found to be resistant in 19 out of 22 (86.36%) and intermediate sensitive in 3 out of 22 (13.63%). Pipracillin out of tazobactum was found to be sensitive in 57/61 (93.44%) patients, resistant in 02/61 (3.27%) patients and intermediate sensitive in 02/61 (3.27%) patients. Cefoperazone was found to be sensitive in 59 out of 66 (89.39%) patients, resistant in 05 out of 66 (7.57%) patients and intermediate sensitive in 02 out of 66 (3.03%) patients. Amikacin was found sensitive in all the 65 out of 65 (100%) patients tested. Gentamycin was found to be sensitive in 65 out of 67 (97.01%) patients, resistant in 01 out of 67 (1.49%) patients and intermediate sensitive in 01 out of 67 (1.49%). Imipenem was found to be sensitive in 66 out of 68 (97.05%) patients, resistant in 01 out of 68 (1.47%) patients and intermediate in 01 out of 68 (1.47%) patients. Cefepime was found to be sensitive in 54 out of 57 (94.73%) patients and resistant in 03 out of 57 (5.26%) patients. Ciprofloxacin was found to be sensitive in 64 out of 68 (94.11%) patients and resistant in 04/68 (5.88%) patients. Trimethoprim or sulphamethoxazole was found to be sensitive in 35 out of 39 (89.74%) patients and resistant in 04 out of 39 (10.29%) patients. Amoxyclav was found to be sensitive in 18/22 (42.85%), resistant in 18/42 (42.85%) patients and intermediate sensitive in 06/42 (14.28%) patients. Similar results were observed in a study by Sridevi et al while studying the prevalence of various microorganisms from throat swab specimens in patients attending a tertiary care hospital at Chinakakani, which shows that the susceptibility patterns varied depending on the drugs, but most of the organisms were susceptible to penicillin, erythromycin and vancomycin.⁶

In a similar study Wakode et al studied 305 throat swab reports and found that isolated bacteria in throat swabs were found to be sensitive with cefotaxime, tetracyline, penicillin and gentamicin.⁷ These results were in line with the results in our study.

Sadoh et al carried out a prospective study to determine the pattern of bacterial isolates and their antibiotic sensitivity amongst children with tonsillo-pharyngitis observed that beta haemolytic streptococcus (BHS) and Staph. aureus showed 100% sensitivity to cefuroxine, azithromycin, ceftazidine and gentamicin. All the isolates had little or no sensitivity to ampicillin and cotrimoxazole.⁸ BHS is a significant cause of pharyngitis and tonsillitis in our environment and therefore poses a potential danger of rheumatic fever and rheumatic heart disease, a non-suppurative sequelae of BHS. Ampicillin and cotrimoxazole two affordable and commonly available drugs are ineffective in tonsillitis and pharygitis. These were similar to the results in our study.

CONCLUSION

To concluded gram positive organisms were resistant to benzyl penicillin or ampicillin, clindamycin, ciprofloxacin or levofloxacin, trimethoprim or sulphamethoxazole and sensitive to tetracycline, gentamicin, linezolid, gram negative organisms were resistant to ampicillin, amoxyclav and sensitive to pipracillin or tazobactum, cefoperazone, amikacin, gentamicin, imipenem, cefepime, ciprofloxacin and trimethoprim or sulphamethoxazole.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

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