Acute tonsillopharyngitis: possibilities of combined treatment
DOI: 10.32364/2587-6821-2024-8-8-6
O.V. Filippova
I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
Acute sore throat is a prevalent concern among patients visiting medical specialists and pharmacies alike. The primary etiology is commonly a combination of acute tonsillitis, characterized by inflammation of the palatine tonsils, and acute pharyngitis, involving inflammation of the posterior and lateral pharyngeal walls. Typically, systemic antibiotic therapy is not necessary for managing these cases. The predominant treatment approach involves the prescription of topical antiseptics delivered through lozenges and sprays. Each formulation, along with its active constituents, has specific attributes that must be considered during treatment tactics.
Topical antiseptic therapy offers several benefits, including direct efficacy at the site of inflammation, minimal systemic absorption, and a low potential for developing microbial resistance. A rational therapeutic strategy involves using a combination of ambazone lozenges, which exert a bacteriostatic effect against various pathogenic microorganisms responsible for acute tonsillopharyngitis, and benzydamine spray, which provides a complementary topical anti-inflammatory action to enhance ambazone's antimicrobial properties. This combination effectively targets multiple aspects of the pathological process, offering a well-rounded therapeutic advantage. The article supports the strategic implementation of this combination therapy.
Keywords: sore throat, pharyngitis, tonsillopharyngitis, ambazone, benzydamine, topical therapy.
For citation: Filippova O.V. Acute tonsillopharyngitis: possibilities of combined treatment. Russian Medical Inquiry. 2024;8(8):477–483 (in Russ.). DOI: 10.32364/2587-6821-2024-8-8-6.
About the author:
Olga V. Filippova — Dr. Sci. (Med.), Professor of the Department of Industrial Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University): 8, build. 2, Trubetskaya str., Moscow, 119991, Russian Federation; ORCID iD 0000-0001-9470-6335.
Contact information: Olga V. Filippova, e-mail: filippova_o_v_3@staff.sechenov.ru.
Financial Disclosure: the author has no a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 15.07.2024.
Revised 07.08.2024.
Accepted 30.08.2024.
2. Moragas A., Sarvisé C., Gómez F. et al. Duration of severe and moderate symptoms in pharyngitis by cause. Aten Primaria. 2024;56(11):102994. DOI: 10.1016/j.aprim.2024.102994.
3. Кугач В.В., Тарасова Е.Н., Куницкий В.С. Фармацевтическое консультирование посетителей аптек при рините и боли в горле. Вестник фармации. 2014;3(65):15–30.Kugach V.V., Tarasova Ye.N., Kunitskiy V.S. Pharmaceutical consultation for pharmacy visitors with rhinitis and sore throat. Vestnik farmatsii. 2014;3(65):15–30 (in Russ.).
4. Sykes E.A., Wu V., Beyea M.M. et al. Pharyngitis: Approach to diagnosis and treatment. Can Fam Physician. 2020;66(4):251–257.
5. Свистушкин В.М., Мокоян Ж.Т., Карпова О.Ю. Возможности эффективной топической монотерапии пациентов с острым тонзиллофарингитом. Consilium Medicum. 2018;20(11):8–12. DOI: 10.26442/20751753.2018.11.180067.Svistushkin V.M., Mokoyan Zh.T., Karpova O.Yu. Potential of effective topic monotherapy in patients with acute tonsillopharyngitis. Consilium Medicum. 2018;20(11):8–12 (in Russ.). DOI: 10.26442/20751753.2018.11.180067.
6. Kenealy T. Sore throat. BMJ Clin Evid. 2011;2011:1509. PMID: 21477389.
7. Valerio C., Di Loreto G., Salvatori E., Cattaneo A. Comparative evaluation of rapidity of action of benzydamine hydrochloride 0.3% oromucosal spray and benzydamine hydrochloride 3 mg lozenges in patients with acute sore throat: A phase IV randomized trial. Medicine (Baltimore). 2023;102(13):e33367. DOI: 10.1097/MD.0000000000033367.
8. Гострый А.В., Симонова А.В., Михайлова Н.А. и др. Хронический фарингит: этиология, патогенез, лечение. Новые подходы к оценке этиопатогенеза. Архивъ внутренней медицины. 2019;9(1):32–43. DOI: 10.20514/2226-6704-2019-9-1-32-43.Gostry A.V., Simonova A.V., Mikhailova N.A. et al. Chronic pharyngitis: etiology, pathogenesis, treatment. New approaches to the estimation of etiopatogenesis. The Russian Archives of Internal Medicine. 2019;9(1):32–43 (in Russ.). DOI: 10.20514/2226-6704-2019-9-1-32-43.
9. Robinson J.L. Paediatrics: how to manage pharyngitis in an era of increasing antimicrobial resistance. Drugs Context. 2021;10:2020-11-6. DOI: 10.7573/dic.2020-11-6.
10. Spinks A., Glasziou P.P., Del Mar C.B. Antibiotics for sore throat. Cochrane Database Syst Rev. 2013;2013(11):CD000023. DOI: 10.1002/14651858.CD000023.pub4. Update in: Cochrane Database Syst Rev. 2021;12:CD000023. DOI: 10.1002/14651858.CD000023.pub5.
11. Bird J.H., Biggs T.C., King E.V. Controversies in the management of acute tonsillitis: an evidence-based review. Clin Otolaryngol. 2014;39(6):368–374. DOI: 10.1111/coa.12299.
12. Little P., Stuart B., Hobbs F.D. et al. Antibiotic prescription strategies for acute sore throat: a prospective observational cohort study. Lancet Infect Dis. 2014;14(3):213–219. DOI: 10.1016/S1473-3099(13)70294-9.
13. Tanael M. Pharyngitis Guidelines and Missional Goals. Mil Med. 2020;185(9-10):e1341–e1342. DOI: 10.1093/milmed/usaa056.
14. Кирилюк А.А. Особенности клинической фармакологии лекарственных препаратов, применяемых для лечения заболеваний горла и полости рта. Вестник фармации. 2023;1(99):48–70. DOI: 10.52540/2074-9457.2023.1.48.Kirilyuk A.A. Features of the clinical pharmacology of drugs used to treat diseases of the throat and oral cavity. Vestnik farmatsii. 2023;1(99):48–70 (in Russ.). DOI: 10.52540/2074-9457.2023.1.48.
15. Chenot J.F., Weber P., Friede T. Efficacy of Ambroxol lozenges for pharyngitis: a meta-analysis. BMC Fam Pract. 2014;15:45. DOI: 10.1186/1471-2296-15-45.
16. Wu Y., Zhang F., Kuang D. et al. Efficacy of botanical lozenges in the treatment of chronic pharyngitis: a randomized controlled trial. Front Pharmacol. 2024;15:1162883. DOI: 10.3389/fphar.2024.1162883.
17. Kalra M.G., Higgins K.E., Perez E.D. Common Questions About Streptococcal Pharyngitis. Am Fam Physician. 2016;94(1):24–31.
18. McNally D., Simpson M., Morris C. et al. Rapid relief of acute sore throat with AMC/DCBA throat lozenges: randomised controlled trial. Int J Clin Pract. 2010;64(2):194–207. DOI: 10.1111/j.1742-1241.2009.02230.x.
19. Кладова О.В., Шамшева О.В. Клинически доказанная эффективность антисептического средства Фарингосепт (Амбазон) за многолетний период его применения в медицинской практике. Практика педиатра. 2017;9(10):66–70.Kladova O.V., Shamsheva O.V. Clinically proven antiseptic Prescribed (Ambazon) for the long period of its application in medical practice. Practice of a pediatrician. 2017;9(10):66–70 (in Russ.).
20. Холодова И.Н. Лечение инфекций верхних дыхательных путей, сопровождающихся развитием острого тонзиллофарингита у детей. РМЖ. Медицинское обозрение. 2019;3(8):44–48.Kholodova I.N. Treatment of the main upper pathways contributing to the development of acute tonsillopharyngitis in children. RMJ. Medical Review. 2019;3(8):44–48 (in Russ.).
21. Jalil A.M., Ismail A. Polyphenols in cocoa and cocoa products: is there a link between antioxidant properties and health? Molecules. 2008;13(9):2190–2219. DOI: 10.3390/molecules13092190.
22. Katz D.L., Doughty K., Ali A. Cocoa and chocolate in human health and disease. Antioxid Redox Signal. 2011;15(10):2779–2781. DOI: 10.1089/ars.2010.3697.
23. De Cassan S., Thompson M.J., Perera R. et al. Corticosteroids as standalone or add-on treatment for sore throat. Cochrane Database Syst Rev. 2020;5(5):CD008268. DOI: 10.1002/14651858.CD008268.pub3.
24. Егорова О.А. Местная терапия боли в горле на фоне антибиотикорезистентности. Медицинский Совет. 2022;8:68–76. DOI: 10.21518/2079-701X-2022-16-8-68-76.Egorova О.А. Local therapy of sore throat against the background of antibiotic resistance. Meditsinskiy sovet. 2022;8:68–76 (in Russ.). DOI: 10.21518/2079-701X-2022-16-8-68-76.
25. Quane P.A., Graham G.G., Ziegler J.B. Pharmacology of benzydamine. Inflammopharmacology. 1998;6(2):95–107. DOI: 10.1007/s10787-998-0026-0.
26. Lisciani R., Barcellona P.S., Silvestrini B. Researches on the topical activity of benzydamine. Eur J Pharmacol. 1968;3(2):157–162. DOI: 10.1016/0014-2999(68)90069-1.
27. Sironi M., Pozzi P., Polentarutti N. et al. Inhibition of inflammatory cytokine production and protection against endotoxin toxicity by benzydamine. Cytokine. 1996;8(9):710–716. DOI: 10.1006/cyto.1996.0094.
28. Bossi P., Gurizzan C., Guntinas-Lichius O. et al. The present and the future of benzydamine: expert opinion paper. Front Oral Health. 2023;4:1191319. DOI: 10.3389/froh.2023.1191319.
29. Nikolaeva-Koleva M., Espinosa A., Vergassola M. et al. Benzydamine plays a role in limiting inflammatory pain induced by neuronal sensitization. Mol Pain. 2023;19:17448069231204191. DOI: 10.1177/17448069231204191.
30. Nicolatou-Galitis O., Bossi P., Orlandi E., René-Jean Bensadoun. The role of benzydamine in prevention and treatment of chemoradiotherapy-induced mucositis. Support Care Cancer. 2021;29(10):5701–5709. DOI: 10.1007/s00520-021-06048-5.
31. Riboldi E., Frascaroli G., Transidico P. et al. Benzydamine inhibits monocyte migration and MAPK activation induced by chemotactic agonists. Br J Pharmacol. 2003;140(2):377–383. DOI: 10.1038/sj.bjp.0705428.
32. Farah B., Visintini S. Benzydamine for Acute Sore Throat: A Review of Clinical Effectiveness and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2018.
33. Passali D., Barat V., Cadevall O. et al. International Delphi-based consensus on the appropriate use and effect of Benzydamine hydrochloride in the treatment of sore throat. BMC Prim Care. 2022;23(1):296. DOI: 10.1186/s12875-022-01901-w.
34. Liu Y., Tong Z., Shi J. et al. Reversion of antibiotic resistance in multidrug-resistant pathogens using non-antibiotic pharmaceutical benzydamine. Commun Biol. 2021;4(1):1328. DOI: 10.1038/s42003-021-02854-z.
35. Ardizzoni A., Boaretto G., Pericolini E. et al. Effects of benzydamine and mouthwashes containing benzydamine on Candida albicans adhesion, biofilm formation, regrowth, and persistence. Clin Oral Investig. 2022;26(4):3613–3625. DOI: 10.1007/s00784-021-04330-8.
36. Fanaki N.H., El-Nakeeb M.A. Antibacterial activity of benzydamine and antibiotic-benzydamine combinations against multifold resistant clinical isolates. Arzneimittelforschung. 1996;46(3):320–323. PMID: 8901158.
37. Слукин П.В., Фурсова Н.К., Брико Н.И. Антибактериальная активность бензидамина гидрохлорида против клинических изолятов бактерий, выделенных от людей в России и Испании. Эпидемиология и Вакцинопрофилактика. 2018;17(6):11–18. DOI: 10.31631/2073-3046-2018-17-11-18.Slukin P.V., Fursova N.K., Briko N.I. Antibacterial Activity of Benzydamine Hydrochloride against Clinical Isolates of Bacteria, isolated from people in Russia and Spain. Epidemiology and Vaccinal Prevention. 2018;17(6):11–18 (in Russ.). DOI: 10.31631/2073-3046-2018-17-6-11-18.

This work is licensed under a Creative Commons «Attribution» 4.0 License.
















