Giulio Cesare Passali

Efficacy and safety of ketoprofen lysine salt mouthwash versus benzydamine hydrochloride mouthwash in acute pharyngeal inflammation: A randomized, single-blind study

BACKGROUND Pharyngodynia, or sore throat, is one of the symptoms most frequently reported by patients to primary care physicians. OBJECTIVE The purpose of this study was to compare the efficacy and tolerability of mouthwash formulations of ketoprofen lysine salt (KLS), an anti-inflammatory agent, and benzydamine hydrochloride (BH), a local anesthetic, in patients with acute inflammation of the pharyngeal cavity. METHODS In this randomized, multicenter, parallel-group, single-blind study, patients (who were blinded) were assigned to receive undiluted BH 15 mL (22.5 mg) or KLS 10 mL (160 mg) diluted in 100 mL of water. Both agents were gargled twice daily until pain remission or up to 7 days. A physical examination of the oropharyngeal cavity was performed, and severity of edema and hyperemia was assessed after 3 days of treatment and, if symptoms had not resolved, after pain remission. RESULTS Of the 241 patients (120 KLS, 121 BH), 239 were included in the safety analysis and 232 were in the intent-to-treat population. The differences between groups in the duration of analgesic effect after the first dose of drug and the time course of pain were found to be statistically significant (P = 0.006 and P = 0.017, respectively), favoring KLS. Adverse drug-related effects reported included numbness of the tissues in the oral cavity, sensation of tingling in the tissues in the oral cavity, dry mouth, thirst, and nausea. A significantly greater proportion of BH-treated patients reported adverse events (P = 0.001 for all adverse events and drug-related adverse events). CONCLUSIONS KLS mouthwash exerts a significantly longer first-application analgesic action with significantly greater local tolerability than BH in patients with pharyngeal pain of inflammatory and/or infectious origin.

Recurrent and chronic inflammations of Waldeyer's ring in childhood: infectious, structural and immunological features

Abstract Objective: To evaluate certain infectious, structural and immunological aspects of the adenoids and tonsils in patients submitted to adenotonsillectomy due to chronic inflammation or massive hypertrophy. Materials and methods: In the first phase, bacterial flora and lymphocytic population were analyzed in the tonsils and adenoids removed from 19 children; in the second phase, histological studies and analysis of the cytokine pattern were carried out in palatine tonsils and adenoids from 105 patients submitted to adenoidectomy and bilateral extracapsular tonsillectomy. Results: The presence of Haemophilus influenzae, Streptococcus pneumoniae and S beta-hemolytic was comparable in both tissues; the most frequently isolated pathogen being H. influenzae. A higher percentage of T3 and T4 lymphocytes was observed in adenoids than in the tonsils. Histologically, of the 105 cases examined, 46 presented hyperkeratosis of the crypt epithelium; in the remaining 59, the epithelium was hyperplastic with no signs of keratosis. A comparison of findings, in serum and tissues, showed a higher concentration of interleukin (IL)-1β and tumor necrosis factor-alpha (TNF-α) in the adenotonsillar specimens, whereas the rise in IL-6 was more modest. Conclusions: The impaired immunological reactivity of the tonsils would appear to be mediated by a change in the epithelial compartment which results in impaired antigen uptake rather than by the lymphatic compartment which only reacts to the repeated stimuli. The high levels of cytokines lead, with repeated infectious stimuli, to activation and proliferation of endothelial cells and fibroblasts which result, with time, in the progressive replacement of immunologically active tissue with fibrotic tissue which is, therefore, immunologically silent.

Multicentric study on the efficacy and tolerability of Streptococcus salivarius 24SMB and Streptococcus oralis 89a in respiratory tract infections

Abstract BACKGROUND. Bacteriocins are peptides with antimicrobial efficacy produced by certain bacterial species. Probiotics indeed seem a promising method in the prevention of upper respiratory infections and our study would like to contribute to the results available in the literature, in order to underlie their true therapeutic potential role. MATERIAL AND METHODS. Our multicenter pilot prospective study investigates 366 patients from September 2015 to February 2016. All the patients were treated with a topical device made up of a suspension of two specific bacterial strains: Streptococcus salivarius 24SMB and Streptococcus oralis 89a to be administered as nasal spray. The nasal spray was administered twice daily for 7 days per month for three consecutive months. A questionnaire about the subjective efficacy of the therapy correlated to an improvement of symptoms was also collected from patients. RESULTS. After one year from the enrolment, a 70.07% reduction in the number of events compared with the number of expected episodes was observed. CONCLUSION. The aim of our data is to propose a new therapeutic approach to treat the recurrence of upper airway infection and to support an adequate therapy in all cases where the traditional antibiotic therapeutic protocol did not obtain completely efficient results in terms of recurrence.

Aetiological Considerations on Chronic Sinusitis and Therapeutic Consequences

The therapeutic rationale of acute or chronic rhinosinusal inflammatory disease must necessarily be based on the correct identification of the microbiological agents involved in causing the sinus affection. In our experience, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are the germs responsible for most of the acute forms found in our country, in adults and children alike. In 1997, the FDA approved the use of antibiotics such as amoxicillin/clavulanic acid, clarithromycin, cefuroxime axetil, loracarbef and levofloxacin for acute forms. According to our experience, the administration of amoxicillin/clavulanic acid would appear to be particularly effective, also in the relapse of chronic forms. Regarding the duration of antibiotic treatment, consensus is practically unanimous. In acute rhinosinusitis, the therapy should be given for at least 10 days at full dosage. The duration of treatment may be extended up to 14 days at the physician’s discretion in the more serious cases of infection and in the case of debilitated patients. In the chronic forms, the common literature indicates a therapy targeted at eradication of coagulase-positive and coagulase-negative staphylococci and anaerobes having a duration of less than 5 weeks. In our opinion, chronic histological modifications of the sinoidal mucosa represent conditions of risk for the appearance of acute episodes, which should necessarily be treated with medical therapy. When the acute episodes recur with incessant regularity, leading to important problems and causing a decrease in quality of life, then functional surgery should be considered.