What is uvulitis. How is uvulitis diagnosed. What causes uvulitis. What are the symptoms of uvulitis. How is uvulitis treated. What is the prognosis for uvulitis. Can uvulitis lead to complications.

Understanding Uvulitis: An In-Depth Look at Uvula Inflammation

Uvulitis is a condition characterized by inflammation of the uvula, the small, tongue-shaped tissue that hangs from the soft palate at the back of the throat. While often overlooked, this condition can cause significant discomfort and, in severe cases, lead to breathing difficulties. To fully grasp the implications of uvulitis, it’s essential to understand the role of the uvula in our oral anatomy and overall health.

The uvula plays several important functions in the human body. It assists in speech production, helps prevent food and liquids from entering the nasal cavity during swallowing, and contributes to the gag reflex. When inflamed, these functions can be impaired, leading to various symptoms that can affect daily life.

The Anatomy of the Uvula and Its Surrounding Structures

To better comprehend uvulitis, we must first explore the anatomy of the oral cavity. The uvula is part of a complex system that includes:

• The soft palate: A muscular structure at the back of the roof of the mouth
• The tonsils: Lymphoid tissue on either side of the throat
• The pharynx: The throat area behind the mouth and nasal cavity
• The epiglottis: A flap that covers the windpipe during swallowing

These structures work together to facilitate breathing, swallowing, and speech. When inflammation occurs in one area, it often affects the surrounding tissues, which is why uvulitis is frequently associated with inflammation of the palate, tonsils, or pharynx.

The Etiology of Uvulitis: Unraveling the Causes

Uvulitis can be triggered by various factors, with bacterial infection being the most common cause. Streptococcus bacteria, particularly group A streptococcus, are often the culprits behind this condition. However, several other factors can contribute to or cause uvulitis:

Infectious Causes of Uvulitis

Bacterial infections are not the only infectious agents that can lead to uvulitis. Viral infections, such as those causing the common cold or influenza, can also result in inflammation of the uvula. In some cases, fungal infections, particularly in immunocompromised individuals, may be responsible.

Allergic Reactions and Uvulitis

Allergic reactions can cause sudden and severe inflammation of the uvula. Common allergens include:

• Pollen
• Dust mites
• Pet dander
• Certain foods (e.g., peanuts, eggs, shellfish)
• Medications

In cases of allergic uvulitis, the reaction can be part of a more generalized response affecting the entire oral cavity and potentially leading to anaphylaxis in severe cases.

Trauma and Injury as Causes of Uvulitis

Physical trauma to the uvula can result in inflammation. This may occur due to:

1. Endoscopic procedures
2. Surgical interventions, such as tonsillectomy
3. Accidental injury from eating hot foods or sharp objects
4. Excessive snoring or sleep apnea

Chemical Irritants and Their Role in Uvulitis

Exposure to certain chemicals can irritate the delicate tissues of the uvula, leading to inflammation. This can occur through:

• Inhalation of toxic fumes
• Ingestion of caustic substances
• Chronic exposure to cigarette smoke or other airborne irritants

Gastroesophageal reflux disease (GERD) can also cause chemical irritation of the uvula due to the backflow of stomach acid into the esophagus and throat.

Recognizing the Symptoms: The Clinical Presentation of Uvulitis

The symptoms of uvulitis can range from mild discomfort to severe pain and difficulty breathing. Understanding these symptoms is crucial for early diagnosis and treatment.

Common Symptoms of Uvulitis

Patients with uvulitis may experience:

• A sensation of something being stuck in the throat
• Difficulty swallowing (dysphagia)
• Pain or discomfort when swallowing
• Excessive salivation
• Altered voice quality or hoarseness
• Coughing or gagging
• Fever, especially in cases of bacterial infection
• Reduced appetite

Severe Symptoms Requiring Immediate Attention

In some cases, uvulitis can progress to more severe symptoms that require urgent medical care:

• Difficulty breathing or shortness of breath
• Severe swelling that obstructs the airway
• High fever accompanied by chills
• Inability to swallow liquids
• Signs of anaphylaxis in allergic reactions

It’s important to seek medical attention if any of these severe symptoms occur, as they may indicate a more serious underlying condition or complication.

Diagnostic Approaches: Identifying and Confirming Uvulitis

Accurate diagnosis of uvulitis is essential for appropriate treatment. Healthcare providers employ various methods to diagnose this condition and determine its underlying cause.

Physical Examination and Visual Inspection

The primary diagnostic tool for uvulitis is a thorough physical examination of the oral cavity. During this examination, the healthcare provider will:

• Visually inspect the uvula for signs of swelling, redness, or discoloration
• Assess the surrounding tissues, including the soft palate and tonsils
• Check for any visible signs of injury or trauma
• Evaluate the patient’s ability to swallow and speak

Laboratory Tests and Cultures

To identify the specific cause of uvulitis, particularly in cases of suspected infection, the following tests may be conducted:

• Throat swab for bacterial culture
• Rapid strep test for group A streptococcus
• Blood tests to check for signs of infection or inflammation
• In some cases, viral or fungal cultures

Allergy Testing

If an allergic reaction is suspected as the cause of uvulitis, allergy testing may be recommended. This can include:

• Skin prick tests
• Blood tests for specific IgE antibodies
• Patch tests for contact allergies

Advanced Imaging Techniques

In complex cases or when complications are suspected, imaging studies may be necessary:

• CT scan of the neck and throat
• MRI to evaluate soft tissue involvement
• Ultrasound to assess for abscesses or other fluid collections

Treatment Modalities: Managing Uvulitis Effectively

The treatment of uvulitis depends on its underlying cause and severity. A multi-faceted approach is often necessary to alleviate symptoms and address the root cause of the inflammation.

Pharmacological Interventions

Medications play a crucial role in treating uvulitis and may include:

• Antibiotics for bacterial infections (e.g., penicillin, amoxicillin)
• Corticosteroids to reduce inflammation (oral or topical)
• Antihistamines for allergic reactions
• Pain relievers and anti-inflammatory drugs (e.g., ibuprofen, acetaminophen)

Supportive Care and Home Remedies

In addition to medical treatments, several supportive measures can help manage symptoms and promote healing:

• Gargling with warm salt water to reduce swelling
• Staying hydrated to prevent dehydration and promote healing
• Using throat lozenges or sprays for pain relief
• Avoiding irritants such as tobacco smoke and spicy foods
• Getting plenty of rest to support the immune system

Surgical Interventions

In rare cases where conservative treatments are ineffective or complications arise, surgical intervention may be necessary. This can involve:

• Partial uvulectomy to remove a portion of the uvula
• Drainage of abscesses if present
• Repair of any structural abnormalities contributing to chronic inflammation

Prognosis and Long-Term Outlook for Uvulitis Patients

The prognosis for uvulitis is generally favorable, with most cases resolving within 1 to 2 days with appropriate treatment. However, the long-term outlook can vary depending on the underlying cause and the individual’s overall health.

Factors Influencing Prognosis

Several factors can affect the prognosis of uvulitis:

• Timeliness of diagnosis and treatment
• The underlying cause (infectious vs. allergic vs. traumatic)
• The patient’s immune system function
• Presence of any comorbid conditions
• Adherence to prescribed treatments

Potential Complications and Their Management

While most cases of uvulitis resolve without incident, potential complications can occur, especially if left untreated:

• Airway obstruction requiring emergency intervention
• Spread of infection to surrounding tissues
• Development of abscesses
• Chronic inflammation leading to tissue changes
• Sleep apnea or other breathing disorders

Prompt recognition and management of these complications are essential to prevent long-term consequences and ensure a full recovery.

Preventive Strategies: Reducing the Risk of Uvulitis

While not all cases of uvulitis can be prevented, certain strategies can help reduce the risk of developing this condition or experiencing recurrences.

Maintaining Good Oral Hygiene

Proper oral care is crucial in preventing infections that can lead to uvulitis:

• Brushing teeth at least twice daily
• Flossing regularly
• Using an antiseptic mouthwash
• Regular dental check-ups and cleanings

Lifestyle Modifications

Certain lifestyle changes can help reduce the risk of uvulitis:

• Quitting smoking and avoiding secondhand smoke
• Limiting alcohol consumption
• Managing allergies through avoidance and proper treatment
• Staying hydrated to keep the throat moist
• Avoiding known irritants and allergens

Proper Management of Underlying Conditions

Effectively managing health conditions that can contribute to uvulitis is essential:

• Treating GERD to reduce acid reflux
• Managing allergies with appropriate medications
• Controlling diabetes to reduce the risk of infections
• Addressing sleep apnea to minimize trauma to the uvula

By implementing these preventive measures, individuals can significantly reduce their risk of developing uvulitis and maintain overall oral health.

Uvulitis Information | Mount Sinai

Swollen uvula

Uvulitis is inflammation of the uvula. This is the small tongue-shaped tissue that hangs from the top of the back part of the mouth. Uvulitis is usually associated with inflammation of other mouth parts, such as the palate, tonsils, or throat (pharynx).

The mouth is the origination of the digestive tract. The teeth and salivary glands aid in breaking down food for digestion. The tonsils aid against infections.

Causes

Uvulitis is mainly caused by an infection with streptococcus bacteria. Other causes are:

• An injury to the back of the throat
• An allergic reaction from pollen, dust, pet dander, or foods such as peanuts or eggs
• Inhaling or swallowing certain chemicals
• Smoking

Injury can occur due to:

• Endoscopy – test that involves inserting a tube through the mouth into the esophagus to view the lining of the esophagus and stomach
• Surgery such as tonsil removal
• Damage due to acid reflux

Symptoms

Symptoms may include any of the following:

• Fever
• Feeling like something is in your throat
• Choking or gagging
• Coughing
• Pain while swallowing
• Excessive saliva
• Decreased or no appetite

Exams and Tests

Your health care provider will perform a physical exam and look in your mouth to view the uvula and throat.

Tests that may done include:

• Throat swab to identify any germs that are causing your uvulitis
• Blood tests
• Allergy tests

Treatment

Uvulitis may get better on its own without medicines. Depending on the cause, you may be prescribed:

• Antibiotics to treat an infection
• Steroids to reduce swelling of the uvula
• Antihistamines to treat an allergic reaction

Your provider may suggest you do the following at home to ease your symptoms:

• Get lots of rest.
• Drink plenty of fluids.
• Gargle with warm salt water to reduce swelling.
• Take over the counter pain medicine.
• Use throat lozenges or a throat spray to help with the pain.
• Don’t smoke and avoid secondhand smoke, both of which can irritate your throat.

If the swelling does not go away with medicines, your provider may advise surgery. Surgery is done to remove a part of uvula.

Outlook (Prognosis)

Uvulitis usually resolves in 1 to 2 days either on its own or with treatment.

Possible Complications

If swelling of uvula is severe and goes untreated, it may cause choking and restrict your breathing.

When to Contact a Medical Professional

Contact your provider if:

• You are unable to eat properly
• Your symptoms are not getting better
• You have a fever
• Your symptoms return after treatment

If you are choking and having trouble breathing, call 911 or go to the emergency room right away. There, the provider may insert a breathing tube to open your airway to help you breathe.

Prevention

If you test positive for an allergy, avoid the allergen in future. An allergen is a substance that can cause an allergic reaction.

Riviello RJ. Otolaryngologic procedures. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts & Hedges’ Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 63.

Wald ER. Uvulitis. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry’s Textbook of Pediatric Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 10.

Last reviewed on: 8/31/2021

Reviewed by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Uvulitis – UF Health

Definition

Uvulitis is inflammation of the uvula. This is the small tongue-shaped tissue that hangs from the top of the back part of the mouth. Uvulitis is usually associated with inflammation of other mouth parts, such as the palate, tonsils, or throat (pharynx).

Alternative Names

Swollen uvula

Causes

Uvulitis is mainly caused by an infection with streptococcus bacteria. Other causes are:

• An injury to the back of the throat
• An allergic reaction from pollen, dust, pet dander, or foods such as peanuts or eggs
• Inhaling or swallowing certain chemicals
• Smoking

Injury can occur due to:

• Endoscopy – test that involves inserting a tube through the mouth into the esophagus to view the lining of the esophagus and stomach
• Surgery such as tonsil removal
• Damage due to acid reflux

Symptoms

Symptoms may include any of the following:

• Fever
• Feeling like something is in your throat
• Choking or gagging
• Coughing
• Pain while swallowing
• Excessive saliva
• Decreased or no appetite

Exams and Tests

Your health care provider will perform a physical exam and look in your mouth to view the uvula and throat.

Tests that may done include:

• Throat swab to identify any germs that are causing your uvulitis
• Blood tests
• Allergy tests

Treatment

Uvulitis may get better on its own without medicines. Depending on the cause, you may be prescribed:

• Antibiotics to treat an infection
• Steroids to reduce swelling of the uvula
• Antihistamines to treat an allergic reaction

Your provider may suggest you do the following at home to ease your symptoms:

• Get lots of rest.
• Drink plenty of fluids.
• Gargle with warm salt water to reduce swelling.
• Take over the counter pain medicine.
• Use throat lozenges or a throat spray to help with the pain.
• Don’t smoke and avoid secondhand smoke, both of which can irritate your throat.

If the swelling does not go away with medicines, your provider may advise surgery. Surgery is done to remove a part of uvula.

Outlook (Prognosis)

Uvulitis usually resolves in 1 to 2 days either on its own or with treatment.

Possible Complications

If swelling of uvula is severe and goes untreated, it may cause choking and restrict your breathing.

When to Contact a Medical Professional

Contact your provider if:

• You are unable to eat properly
• Your symptoms are not getting better
• You have a fever
• Your symptoms return after treatment

If you are choking and having trouble breathing, call 911 or go to the emergency room right away. There, the provider may insert a breathing tube to open your airway to help you breathe.

Prevention

If you test positive for an allergy, avoid the allergen in future. An allergen is a substance that can cause an allergic reaction.

Images

References

Riviello RJ. Otolaryngologic procedures. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts & Hedges’ Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 63.

Wald ER. Uvulitis. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry’s Textbook of Pediatric Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 10.

Last reviewed August 31, 2021 by Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team..

Related specialties

Uvulitis (inflammation of the uvula) – causes, symptoms and treatment

Definition of the disease: what is uvulitis

Uvulitis is an acute inflammation of the uvula or uvula. Translated from Latin, uvula means “tongue” – the shape of the organ resembles an oblong berry.

Uvula helps to pronounce specific “trembling” sounds – such are, for example, in French, Arabic, Georgian and Native American languages.

This small process is located at the entrance to the larynx – along the median line of the posterior edge of the soft palate. The uvula secretes saliva, pushes food along with the tongue to the esophagus and, when swallowed, closes the nasal passages so that pieces of food and liquid do not get there.

Uvulu is easy to see if you open your mouth wide and look in the mirror – this is a “drop” that hangs over the base of the tongue

The uvula is a very sensitive and delicate organ. It consists of connective tissue and is covered with a mucous membrane. If for some reason (for example, due to infection, severe coughing or smoking) the vessels inside the uvula burst, a hematoma is formed. – the palatine uvula swells, severe pain appears.

Causes of uvulitis

Uvulitis rarely occurs as an independent disease – most often inflammation develops against the background of viral and bacterial infections of the upper respiratory tract. For example, during a sore throat or pharyngitis, the doctor, upon examination, may see that the uvula has turned red and a white coating has appeared on it – a trace that bacteria leave on the mucous membrane.

The uvula can also become swollen and painful due to smoking, improper gastrointestinal function, or allergies to food, pollen, and pets.

Possible causes of uvula inflammation:

• viral infections: uvulitis may be a concomitant symptom of diseases caused by influenza viruses, herpes viruses, adenoviruses, coronaviruses and Epstein-Barr virus. For example, the uvula becomes inflamed with tonsillitis, pharyngitis, and laryngitis. In some patients, uvulitis appears against the background of COVID-19;
• Bacterial and fungal infections: Streptococci, Staphylococcus aureus and Haemophilus influenzae can also cause uvula inflammation. Often uvulitis becomes a complication of oral candidiasis (thrush) – damage to the oral cavity by fungi of the genus Candida;
• allergy: edema may be the body’s reaction to an antigen – a substance that the immune system perceives as suspicious and tries to destroy. If the allergic reaction is particularly strong, Quincke’s edema can develop – a dangerous condition when the eyes, lips, tongue and uvula suddenly swell;
• genetic feature: with congenital angioedema, the body lacks a special protein that restrains the immune system and prevents it from attacking its own body by mistake. In people with this pathology, edema may appear in different parts of the body even due to cold, some foods and minor injuries;
• exposure to chemicals and tobacco: uvula has been known to become inflamed after inhaling gasoline, paint, solvents, tobacco smoke, and e-cigarette fumes;
• snoring or severe coughing can be both causes and symptoms of uvulitis;
• dehydration: when the body loses water – due to overheating, diarrhea, vomiting or improper drinking regimen – it tries to retain the remaining fluid in organs and tissues, which may cause edema, including edema of the uvula;
• sexually transmitted diseases: gonorrhea and syphilis often cause inflammation of the larynx, tonsils, gums, tongue and uvula;
• gastroesophageal reflux disease (GERD): a disease of the digestive system in which many patients experience laryngopharyngeal reflux, the backflow of gastric juice into the esophagus and then into the throat, leading to inflammation in the oral cavity;
• injuries: uvulitis is often a complication after surgery, when the patient is intubated – a plastic tube is inserted that helps the person breathe under anesthesia.

Symptoms of uvulitis

With uvulitis, the sore throat usually comes on suddenly when eating, after a sudden cough or sneeze. Sometimes the uvulitis makes itself known for the first time at night – it becomes difficult for a person to breathe, there may be a feeling that a lump is stuck in the throat. At the same time, if you try to clear your throat, the pain will only increase.

The main symptom of uvulitis is unbearable and sudden pain in the throat

Other common symptoms of uvulitis:

• high body temperature and chills;
• Gagging – appear because the enlarged uvula presses on the root of the tongue;
• dry cough that brings no relief;
• shortness of breath;
• increased salivation;
• white coating on tongue and uvula;
• snoring.

Uvulitis diagnostics

Sometimes uvulitis goes away on its own in a few days. But if the symptoms persist longer and the general state of health has worsened, you need to tell the doctor – therapist or otolaryngologist about this.

The doctor will examine – swelling, bright red or bluish color of the palatine uvula, film and sores on its tip will indicate uvulitis.

Immediate medical attention may be required if breathing becomes difficult and shortness of breath worsens.

Laboratory diagnostics

Laboratory tests may be required to clarify the diagnosis and understand the true cause of uvula inflammation.

A complete blood count with a leukocyte formula will help to understand the nature of the inflammation – it is associated with a viral, bacterial or fungal infection.

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To accurately diagnose the causes of uvulitis, it is important to understand which viruses triggered the inflammation.

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If, upon examination, a gray or yellowish coating is noticeable on the uvula and the patient has enlarged lymph nodes, liver and spleen, this may be a symptom of infectious mononucleosis, a disease caused by the Epstein-Barr virus.

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If an allergy is suspected, allergy tests are performed – tests that help to understand which antigen triggers the reaction. Allergic uvulitis can be triggered by any allergen — plant pollen, food, dust, and pet dander.

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Treatment of uvulitis

Usually, the uvula quickly returns to normal if the underlying disease is dealt with. The doctor will select the treatment – it depends on the cause of the uvulitis.

If swelling is due to allergies, antihistamines are prescribed.

Antivirals, antifungals, or antibiotics may be needed to clear the infection if the infection is caused by bacteria.

In case of severe edema and to relieve inflammation, the doctor may recommend physiotherapy procedures – drug inhalations and phonophoresis Phonophoresis A method of physiotherapy that combines the use of drugs and the action of ultrasonic high-frequency waves..

Treatment of uvulitis at home

Regardless of the cause of uvulitis, symptomatic treatment is prescribed to alleviate the condition – lozenges and sprays for sore throat. To reduce swelling and pain, you can gargle with warm salt water – one teaspoon of salt per glass of water.

It is also useful to drink plenty of warm water – this will help minimize the effects of intoxication in case of infectious uvulitis. In addition, it is important to monitor the humidity in the room: dry air will irritate the uvula, which can lead to a coughing fit.

It is advisable to give up solid food for a while in favor of pureed soups and mashed potatoes.

Prognosis of uvulitis and possible complications

With timely diagnosis, the disease responds well to treatment and rarely leads to complications. Uvulitis itself is not contagious, but viruses and bacteria are transmitted from person to person, which cause inflammation of the uvula.

Isolated uvulitis rarely causes severe complications. The danger is diseases due to which the palatine uvula has increased, including angioedema and false croup.

Sometimes uvulitis turns from an acute form into a chronic one: edema and pain are not amenable to conservative treatment and often return. In this case, an operation may be required – removal of part of the uvula.

There is no absolute protection against uvulitis, but you can reduce the risk of inflammation of the palatine uvula if you follow personal hygiene measures during respiratory infections, stop smoking, monitor your drinking regimen and avoid meeting with allergens that can cause uvula edema.

Sources

1. Babiyak V. I. Otorhinolaryngology. Volume 1. St. Petersburg, 2009. S. 476.
2. Uvulitis / Health Library by Cleveland Clinic. 2022.
3. Lathadevi H. T., Karadi R. N., Thobbi R. V., Guggarigoudar S. P., Kulkarni N. H. Isolated uvulitis: An uncommon but not a rare clinical entity // Indian J Otolaryngol Head Neck Surg. 2005. No. 57(2). P. 139–140. doi:10.1007/BF02907669

Uvulitis | Causes of occurrence

12/31/2018

Inflammation of a small process located on the posterior edge of the palate, occurring in an acute form, is called uvulitis. The onset of the pathological process is characterized as rapid, and its main manifestations are severe pain in the throat , sensation of a foreign body and difficulty breathing. The uvula plays a significant role in the formation of sounds , and also has protective functions, preventing food from entering the nasopharynx. The pathological process proceeds both in acute and in chronic form.

Causes of uvulitis

As the most likely causes of uvulitis, it is necessary to indicate damage to blood vessels in the palatine uvula, tonsillitis , rhinitis, sinusitis, caries, consequences of adenotomy, tonsillar abscess, trauma to the palatine uvula, 9 0023 allergic reactions organisms, thermal lesions of the oral cavity , side effects of a number of pharmacological preparations, especially those taken uncontrollably. Most often, uvulitis occurs after surgery for removal tonsils or adenoids .

Depending on the causes of the development of the pathological process, uvulitis is divided into medicinal, traumatic, allergic, viral and bacterial. Predominantly, the disease develops due to the pathogenic activity of a number of microorganisms. The main route of entry of pathogens of the infectious process into the palatine uvula is hematogenous.

Symptoms of uvulitis

In addition to the above characteristic manifestations of uvulitis, the symptoms of the disease are: swelling and redness of the uvula, hyperthermia, headache of moderate intensity, increased body fatigue, muscle pain, excessive salivation, impaired speech , ulcerative formations on the mucous membrane of the palatine uvula, cough, itching in the throat .

Allergic uvulitis may be accompanied by runny nose and skin rashes. The development of the inflammatory process proceeds very brightly and cannot be classified as ailments. The appearance of the above symptoms should be the reason for the immediate appeal to the doctor and urgent therapy . Practitioner in the field of diagnosis and treatment of uvulitis is otolaryngologist .

Doctor attaches great importance to the symptoms of the inflammatory process, which the patient tells him about. Next, the specialist proceeds to the examination, during which he establishes the need for additional laboratory research procedures. To determine the nature of the development of the pathological process, general and biochemical blood tests allow, and a bacteriological analysis of a smear from the mucous membrane of the palatal uvula helps to identify the direct infectious agent. Identification of the causative microorganism plays a decisive role in the choice of antimicrobials during the therapy .