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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 16  |  Issue : 1  |  Page : 76-79

Role of ayurveda in antimicrobial resistant pharyngitis


1 Department of Panchkarma, Gaur Brahmin Ayurvedic College, Rohtak, Haryana, India
2 Department of Dravyaguna, Shri Baba Mastnath Ayurvedic College, Rohtak, Haryana, India
3 Department of Panchkarma, Shri Krishna AYUSH University, Kurukshetra, Haryana, India

Date of Submission07-Apr-2020
Date of Decision07-Jun-2021
Date of Acceptance26-Jun-2021
Date of Web Publication19-Mar-2022

Correspondence Address:
Anshul
Department of Panchkarma, Gaur Brahmin Ayurvedic College, Brahmanwas, Rohtak, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_98_21

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  Abstract 


Introduction: Purpose of the study is to manage recurrent pharyngitis (Ekvrindamukharoga) because antibiotic resistance issue is a big concern as there is no permanent management in conventional medicine. Main Clinical Finding & Diagnosis: The present case was diagnosed with viral pharyngitis on basis of fever, sore throat &lymphocytosis. Interventions: TalishadiChurna, Mrityunjaya rasa, Laxmivilasa rasa & Tankana were administered for 3 days and subsequently Vamana (~induced therapeutic vomiting) was performed to prevent recurrence. Outcome: Major improvement recorded in oral temperature, color (beefy red to light pink), etc., after the intervention. Throat pain (from 5 point to 1) and swelling (from 2 to 1) after 2 h and were relieved completely after 3 days. Conclusion: This case study reports effective management of antimicrobial-resistant acute pharyngitis with stand-alone Ayurvedic therapy. Non-relapse of symptoms after Vamana during the follow-up period (6 months) emphasizes the effective secondary prevention achieved with Ayurveda.

Keywords: Acute pharyngitis, Ayurveda, Ekavrinda, Mukharoga, sore throat


How to cite this article:
Anshul, Rohilla P, Mehta A. Role of ayurveda in antimicrobial resistant pharyngitis. J Ayurveda 2022;16:76-9

How to cite this URL:
Anshul, Rohilla P, Mehta A. Role of ayurveda in antimicrobial resistant pharyngitis. J Ayurveda [serial online] 2022 [cited 2022 Nov 29];16:76-9. Available from: http://www.journayu.in/text.asp?2022/16/1/76/339993




  Introduction Top


Pharyngitis is a common complaint encountered by clinicians, worldwide. National Hospital Ambulatory Medical Care Survey has documented five million visits to primary care physicians, and emergency departments each year for adults.[1] Usually, antibiotics are prescribed in acute pharyngitis cases, but antibiotic resistance issue has been a concern.[2] Therefore, a safe and effective management of antimicrobial-resistant pharyngitis is required. Ayurveda offers a holistic therapeutic approach for management of diseases safely.

Ayurvedic descriptions of Ekavrinda resonate with pharyngitis. For managing the present case, Ayurvedic treatment principles of Mukhagata rogas (throat diseases) of Ashtanga Hridaya were followed.[3]


  Case Report Top


A 29-year-old male patient, resident of Haryana, presented with complaints of recurrent sore throat, foreign-body sensation, and alteration of voice for one day. He had recurrent episodes three-four times per year in the last 2 year. The patient had occasional addiction of alcohol (once/twice a month). He was hypertensive for the last 7 years. He had developed fever, throat pain, difficulty in swallowing, and rhinorrhea from one day before the first visit. Previously, he had no relief after taking antibiotics (amoxicillin, azithromycin) and NSAIDs (paracetamol and diclofenac) prescribed by ENT specialist.

The patient had fever 100°F, tonsillar exudates, and pharyngeal erythema without any cervical adenopathy, trismus, or stridor. The patient was assessed to have Vata-dominated Paitika Nadi, Malavritta Jihva (~coated tongue), Nirama Mala (~Formed stool), Pandu-Mutra (~yellow urine), Kathina Shabda (~hoarse speech), and Ushna Sparsa (~warm touch).

Diagnosis

Investigations

Complete blood count (hemoglobin, total leukocyte count, and differential leukocyte count), liver function test, kidney function test, and thyroid and lipid profile were within the normal limits except mild increased lymphocytes. Throat culture and TRIDOT test were negative.

Clinical examination was done to ruled out the nonviral causes of pharyngitis owing to absence of retropharyngeal abscess, neck stiffness, pain during neck extension, stridor, etc. Epstein–Barr virus was ruled out due to the absence of atypical lymphocytes and hepatosplenomegaly. Negative TRIDOT test excluded any possibility of retroviral syndromes. Therefore, viral pharyngitis was diagnosed, based on the presenting lymphocytosis, rhinorrhea, and other symptoms like fever.[1]

Clinical assessment

The patient was assessed using the Tonsillo-Pharyngitis Assessment Scale [Figure 1].[4] Visual Analog Scale (100-mm) was employed to evidence the features of sore throat pain intensity, difficulty swallowing, and the sensation of a swollen throat.[4]
Figure 1: Tonsillo-Pharyngitis Assessment Scale – To assess oral temperature, oropharyngeal color, and other oropharyngeal features

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Intervention given

Ayurvedic herbo-mineral formulations comprising 2 g of Talishadichurna,[5] 125 mg Mrityunjay rasa (MR),[6]125 mg Laxmivilas rasa (LVR),[7] and 500 mg Tankana[8] were administered in combination for relief in symptoms. These medicines were administered orally after meal without any Anupana to exert local effect. It was repeated twice a day for the next 3 days.

After resolution of the presenting symptoms, Vamana therapy was administered for secondary prevention. Snehapana with Goghrita for 4 days and Sarvanga Abhyanga with Tila tail and Swedana for 1 day were performed prior to Vamana. Madanaphalapippali churna with honey, Vacha, Saindhava lavana, and Madhuyashti phanta (as mentioned in classics) were used for Vamana.

Timeline

Timeline of interventions and outcome of antimicrobial-resistant acute pharyngitis [Figure 2].
Figure 2: Timeline showing details of Ayurvedic management of Antimicrobial resistant pharyngitis

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Outcome and follow-ups

Outcomes were assessed at four time points. The first assessment was done prior to administration of the intervention and the second assessment was done after 2 h of the intervention (day one). The third assessment was done prior to the administration of the third dose and the fourth assessment was done after administration on day 3.

Tonsillo-pharyngeal assessment showed marked improvement in oral temperature (i.e., >100°F to 98.8°F), color (beefy red to light pink), etc., within 2 h of initial dose and significant changes after 3 days. Throat pain and swelling were also relieved completely after 3 days.

Local analgesic effect was perceived by the patient after administration of the intervention. Symptoms such as throat pain and difficulty in swallowing associated with acute pharyngitis were resolved within 72 h, as summarized in [Table 1] and [Table 2]. There was no relapse of symptoms after Vamana karma during the 6-month follow-up period. Adherence and tolerability of interventions were also assessed revealing no reported adverse event during the treatment and follow-up period.
Table 1: Tonsillo-pharyngitis assessment before and after treatment

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Table 2: Visual Analogue Scale grading before and after treatment

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  Discussion Top


Ekavrinda (~pharyngitis) is described as Mukharoga in Ayurvedic classics for which Acharya Sushruta has mentioned Shodhanavidhi followed by Pratisarana.[9] In this case, a combination of oral herbo-mineral preparations was administered to provide therapeutic effects locally (as the drugs with sukshma guna may penetrate deep into layers of pharynx mucosal tissue) which is observed as relief in pain.

The present case has befitting indications for the said medicines due to resistance to the antimicrobial therapy. LVR was used owing to its fast action, as indicated in Ayurvedic classics.[7] MR is usually indicated in chronic diseases.[10] LVR and MR are also reportedly administered in hypertensive conditions associated with lung disease/respiratory tract infection, all kind of fever.[7],[10] Moreover, these medicines are indicated for Sannipatika and respiratory conditions.[6],[7] Tankan and Talishadichurna were administered due to their documented healing pharmacological properties.[5],[8],[11] In certain conditions such as rhinorrhea (excess secretion and inflammation resonating aggravated Kapha and Rakta activity respectively), fever and hypertension (resonating Pitta and Rakta involvement), and throat pain (Vata-raktadosha vitiation) are supposed to respond to Shodhan therapy. Moreover, Shodhana therapy helps in prevention of reoccurrence of disease.

The administered Ayurvedic treatment ameliorated the presenting disease symptoms without any reported side effects. Although the interventional medicines exhibited properties like anti-inflammatory, analgesics, the mechanism of action is still to be understood. It needs to be explored further research studies. More objective parameters are warranted to compare the changes exhibited pre- and postintervention changes.


  Conclusion Top


This case report shows the positive efficacy of stand-alone Ayurveda management in recurrent antibiotic-resistant acute pharyngitis. Orally administered herbo-mineral formulations exerted symptomatic relief in acute pharyngitis cases. Further studies are required to validate the results with randomized clinical trials.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
  References Top

1.
Flores RA, Caserta TM. Pharyngitis. In: Mandell, Douglas, and Benett's Principles and Practice of Infectious Diseases. Vol. 1. Philadelphia, Churchill Livingstone , Elsevier Publication; 2015. p. 753-9.  Back to cited text no. 1
    
2.
Ng GJ, Tan S, Vu AN, Del Mar CB, van Driel ML. Antibiotics for preventing recurrent sore throat. Cochrane Database Syst Rev 2015;(7):CD008911. doi: 10.1002/14651858.CD008911.pub2. PMID: 26171901.  Back to cited text no. 2
    
3.
Gupt AD. Vidyotini Hindi Commentary of Vagbhata on Asthanga Hridaya- Uttartantra, Reprint 1st ed., Ch. 22., Ver. 109. Varanasi: Chaukhambha Prakashan; 2011. p. 725.  Back to cited text no. 3
    
4.
Schachtel B, Aspley S, Shephard A, Shea T, Smith G, Schachtel E. Utility of the sore throat pain model in a multiple-dose assessment of the acute analgesic flurbiprofen: A randomized controlled study. Trials 2014;15:263. [doi: 10.1186/1745-6215-15-263].  Back to cited text no. 4
    
5.
Anonymous. Ayurvedsaarasamgraha. 1st ed. Kolkata: Shree Baidyanath Ayurved Bhavan Limited; 2018. p. 668-9.  Back to cited text no. 5
    
6.
Anonymous. Ayurvedsaarasamgraha. 1st ed. Reprint 2018. Kolkata: Shree Baidyanath Ayurved Bhavan Limited; 2018. p. 425-6.  Back to cited text no. 6
    
7.
Anonymous. Ayurvedsaarasamgraha. 1st ed. Reprint 2018. Kolkata: Shree Baidyanath Ayurved Bhavan Limited; 2018. p. 426-7.  Back to cited text no. 7
    
8.
Parajuli S, Dahal A, Bhatta P. Effectiveness of Tankana Bhasma Kavala in chronic tonsillitis. J Ayurveda Integr Med Sci 2021;6:41-4.  Back to cited text no. 8
    
9.
Samhita S, Sathan N. Mukharoganidana, 16/55-56. Available from: http://niimh.nic.in/ebooks/esushruta/?mod=adhi. [Last accessed on 2021 Jan 31].  Back to cited text no. 9
    
10.
Agrawal S, Prasad AB, Gautam M, Dwivedi L. Antimicrobial study of mrityunjaya rasa. Int Ayurvedic Med J 2014;2:243-7.  Back to cited text no. 10
    
11.
Swati R. Development and study of wound healing activity of an Ayurvedic formulation. Asian J Res Pharm Sci 2011;1:26-8.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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