Pharyngitis—Principles of Judicious Use of Antimicrobial Agents

PEDIATRICS ◽  
1998 ◽  
Vol 101 (Supplement_1) ◽  
pp. 171-174 ◽  
Author(s):  
Benjamin Schwartz ◽  
S. Michael Marcy ◽  
William R. Phillips ◽  
Michael A. Gerber ◽  
Scott F. Dowell
Keyword(s):  
Antimicrobial Agents ◽  
Low Cost ◽  
Streptococcal Pharyngitis ◽  
Clinical Findings ◽  
Group A Streptococci ◽  
Throat Culture ◽  
Drug Of Choice ◽  
Group A ◽  
Resistant Group ◽  
Test Result

Accurate diagnosis of group A streptococcal pharyngitis and appropriate antimicrobial therapy are important, particularly to prevent nonsuppurative sequelae such as rheumatic fever. Most episodes of sore throat, however, are caused by viral agents. Clinical findings cannot reliably differentiate streptococcal from viral pharyngitis and most physicians tend to overestimate the probability of a streptococcal infection based on history and physical examination alone. Therefore, diagnosis should be based on results of a throat culture or an antigen-detection test with throat culture backup. Presumptively starting therapy pending results of a culture is discouraged because treatment often continues despite a negative test result. Other bacterial causes of pharyngitis are uncommon and often can be diagnosed based on nonpharyngeal findings. Penicillin remains the drug of choice for streptococcal pharyngitis because of its effectiveness, relatively narrow spectrum, and low cost. No group A streptococci are resistant to β-lactam antibiotics. High rates of resistance to macrolides has been documented in several areas; in Finland, decreased national rates of macrolide use led to a decline in the proportion of macrolide-resistant group A streptococci.

Duration of Positive Throat Cultures for Group A Streptococci After Initiation of Antibiotic Therapy

PEDIATRICS ◽  
1993 ◽  
Vol 91 (6) ◽  
pp. 1166-1170 ◽  
Author(s):  
Leonard W. Snellman ◽  
Howard J. Stang ◽  
Jill M. Stang ◽  
Dwight R. Johnson ◽  
Edward L. Kaplan
Keyword(s):  
Antibiotic Therapy ◽  
Positive Culture ◽  
Streptococcal Pharyngitis ◽  
Clinical Findings ◽  
Group A Streptococci ◽  
Throat Culture ◽  
Health Maintenance ◽  
Negative Culture ◽  
Group A ◽  
Erythromycin Estolate

Objective. To determine if it is appropriate to recommend that patients with group A β-hemolytic streptococcal pharyngitis, who are clinically well by the morning after starting antibiotic treatment, can return to school or day care, or if they should wait until they have completed 24 hours of antibiotics as recommended by the American Academy of Pediatrics Committee on Infectious Diseases. Methods. We examined the duration of positivity of the throat culture after antibiotics were begun as a means of assessing the potential risk of transmission to close school contacts. Forty-seven children (4 to 17 years of age) with pharyngitis and a positive throat culture for group A streptococci in an outpatient, staff model health maintenance organization clinic were enrolled and were randomly selected to receive therapy with either oral penicillin V, intramuscular benzathine penicillin G, or oral erythromycin estolate. Additional throat cultures were obtained and clinical findings were recorded for each child during three home visits in the 24 hours after their initial clinic visit. Acute and convalescent sera were obtained for determination of anti-streptolysin O and anti-DNase B titers. Results. Seventeen (36.2%) of the 47 patients had a positive culture the morning after initiating antibiotic therapy. However, thirty-nine (83%) of the patients became "culture negative" within the first 24 hours. Neither the time interval to the first negative culture nor the presence or absence of group A streptococcal organisms on any single convalescent culture could be predicted by clinical findings. Six of the eight children who failed to convert to a "negative" throat culture within 24 hours of initiating therapy were receiving erythromycin. We could detect no difference in either time to conversion to a negative culture or the presence of a positive culture 24 hours after starting antibiotics between those who demonstrated a significant antibody increase and those who did not. Conclusion. The data from this study strongly suggest that children with group A β-hemolytic streptococcal pharyngitis should complete a full 24 hours of antibiotics before returning to school or daycare.

scholarly journals Prevalence of Polyclonal mefA-Containing Isolates among Erythromycin-Resistant Group A Streptococci in Southern Taiwan

2000 ◽  
Vol 38 (7) ◽  
pp. 2475-2479 ◽  
Author(s):  
Jing-Jou Yan ◽  
Hsiu-Mei Wu ◽  
Ah-Huei Huang ◽  
Hsiu-Mei Fu ◽  
Chen-Ting Lee ◽  
...  
Keyword(s):  
University Hospital ◽  
Group A Streptococci ◽  
Erythromycin Resistance ◽  
Drug Of Choice ◽  
High Incidence ◽  
Group A ◽  
Agar Dilution ◽  
Southern Taiwan ◽  
Resistant Group ◽  
Gene 4

A total of 204 nonrepetitive isolates of group A streptococci (GAS), including 107 randomly collected between 1992 and 1995 and 66 and 31 consecutively collected in 1997 and 1998, respectively, from a university hospital in southern Taiwan were examined to determine the prevalence and mechanisms of erythromycin resistance among these isolates. Resistance to erythromycin was detected in 129 isolates (63.2%) by the agar dilution test. Of these, 42 isolates (32.6%) were assigned to the constitutive macrolide, lincosamide, and streptogramin B resistance (cMLS) phenotype, and all carried the ermBgene; 4 (3.1%) were assigned to the inducible MLS resistance (iMLS) phenotype, and all harbored the ermTR gene; and 83 (64.3%) were erythromycin resistant but susceptible to clindamycin (M phenotype), and all possessed the mefA gene. Distributed by years, the rates of erythromycin resistance and different phenotypes were 61.7% (53.0% cMLS, 6.1% iMLS, and 40.9% M phenotype) between 1992 and 1995, 62.1% (12.2% cMLS and 87.8% M phenotype) in 1997, and 71.0% (9.1% cMLS and 90.9% M phenotype) in 1998. Pulsed-field gel electrophoresis showed that all but 2 cMLS isolates were clonal in origin, and 17 clones were detected among the M-phenotype isolates. These results indicate that the high incidence and increasing rate of erythromycin-resistant GAS in southern Taiwan are due to the prevalence of multiple M-phenotype clones and that clindamycin may be the drug of choice for the treatment of infections with GAS in penicillin-hypersensitive patients in this area.

Throat Cultures

PEDIATRICS ◽  
1994 ◽  
Vol 93 (3) ◽  
pp. 539-539
Author(s):  
Ellen R. Wald
Keyword(s):  
Antibiotic Therapy ◽  
Streptococcal Pharyngitis ◽  
Group A Streptococci ◽  
Throat Culture ◽  
Group A ◽  
To Receive

I read with great interest the article entitled "Duration of Positive Throat Cultures for Group A Streptococci After Initiation of Antibiotic Therapy" by Snellman et al.1 The study involved 47 patients in whom streptococcal pharyngitis was diagnosed, who were randomly selected to receive three different antimicrobial regimens with a varying number of doses before the performance of a repeat throat culture. The degree of positivity of the persistently positive cultures (1+, 2+, or 3+) was not shown.

scholarly journals A clinical decision rule for streptococcal pharyngitis management: An update

2017 ◽  
Vol 9 (02) ◽  
pp. 116-120 ◽  
Author(s):  
Hosain Nasirian ◽  
Saeedeh TarvijEslami ◽  
Esfandiar Matini ◽  
Seyedehsara Bayesh ◽  
Yasaman Omaraee
Keyword(s):  
Decision Rule ◽  
Positive Culture ◽  
Clinical Decision ◽  
Streptococcal Pharyngitis ◽  
Clinical Findings ◽  
Common Disease ◽  
Clinical Decision Rule ◽  
Throat Culture ◽  
Group A ◽  
Culture Negative

Abstract PURPOSE: Group A streptococcal (GAS) pharyngitis is a common disease worldwide. We aimed to establish a pragmatic program as a clinical decision rule for GAS pharyngitis diagnosis. MATERIALS AND METHODS: This article derived from a research project on children aged 6–15 years. Five hundred and seventy-one children met the enrollment criteria on whom throat culture and validities of clinical findings were assessed in positive and negative throat culture groups. RESULTS: Positive GAS throat culture group included 99 (17.3%) patients with a positive culture. Negative GAS throat culture group included 472 (82.6%) patients. Exudate or enlarged tender nodes each one had 63% and 68% sensitivity and 31.5% and 37.5% specificity with a high percentage of negative predictive value (NPV) 80.54% and 85.09%, respectively. Sequence test revealed validities of exudate plus enlarged nodes at 43.62% sensitivity and 57.19% specificity with 83% NPV. CONCLUSIONS: High NPV of 83% indicated that similar prevalence in the absence of either exudate or enlarged tender lymph nodes. Probability of GAS negative throat cultures among children suspected of GAS pharyngitis was 83% and would correctly not receive inopportune antibiotics.

scholarly journals Streptococcal pharyngitis in general practice. 1. Some unusual features of the epidemiology

1992 ◽  
Vol 109 (2) ◽  
pp. 181-189 ◽  
Author(s):  
P. M. Higgins
Keyword(s):  
Sore Throat ◽  
Age Distribution ◽  
Positive Culture ◽  
Streptococcal Pharyngitis ◽  
Group A Streptococci ◽  
Upper Respiratory Tract ◽  
Acute Infections ◽  
Group A ◽  
Upper Respiratory ◽  
Highly Correlated

SUMMARYThis report is based on a study of acute infections of the upper respiratory tract in 1965 and detailed records of such infections in 1963 and 1964. A change from illnesses mainly yielding viruses to illnesses mainly yielding group A streptococci was noted around the age of 5 years. A positive culture for group A streptococci in patients over 4 years of age was highly correlated with a complaint of sore throat and with serological evidence of streptococcal infection. A bimodal age distribution curve for pharyngitis associated with a positive culture for group A streptococci was consistently noted. The incidence was highest in children aged 5–9 but a second smaller peak occurred among adults in the 30–39 age group. The evidence suggests that being female increases the risk of acquiring group A streptococci and of experiencing sore throat.

New Colorimetric Test for Rapid Diagnosis of Streptococcal Pharyngitis: A Warning

PEDIATRICS ◽  
1990 ◽  
Vol 86 (3) ◽  
pp. 457-459
Author(s):  
Michael A. Gerber ◽  
Richard R. Facklam ◽  
Martin F. Randolph ◽  
Kathleen K. DeMeo
Keyword(s):  
Drug Administration ◽  
Diagnostic Tests ◽  
Streptococcal Pharyngitis ◽  
Rapid Diagnosis ◽  
Group A Streptococci ◽  
Pharmacologic Agent ◽  
The Past ◽  
Colorimetric Test ◽  
Group A ◽  
Rapid Tests

During the last few years there has been a dramatic proliferation of rapid tests for the diagnosis of group A β-hemolytic streptococcal pharyngitis.1 It is important for physicians to realize that the Food and Drug Administration does not approve these diagnostic tests as it would approve a pharmacologic agent, but simply permits a manufacturer to sell the test. Consequently, unacceptably inaccurate rapid tests for group A streptococci have been marketed in the past and could potentially appear again at anytime. In 1986, we studied a new enzyme fluorescence procedure (Strep-A-Fluor, Bio-Spec Inc, Dublin, CA) for the rapid diagnosis of group A β-hemolytic streptococcal pharyngitis.2

scholarly journals Value of rapid test for identification of beta hemolytic Streptococcus antigens in children with Streptococcal pharyngitis

2004 ◽  
Vol 132 (suppl. 1) ◽  
pp. 39-41 ◽  
Author(s):  
Branimir Nestorovic ◽  
Suzana Laban-Nestorovic ◽  
Veselinka Paripovic ◽  
Katarina Milosevic
Keyword(s):  
Group A Streptococcus ◽  
Rapid Test ◽  
Streptococcal Pharyngitis ◽  
Early Spring ◽  
Group A Streptococci ◽  
Upper Respiratory Tract ◽  
Isolation And Identification ◽  
Cervical Lymph Nodes ◽  
Group A ◽  
Tract Infections

Beta-hemolytic group A streptococcus (Streptococcus pyogenes) is the most common bacterial agent associated with the upper respiratory tract infections in humans. The most frequently group A streptococcus-associated disease is pharyngitis. Males and females are equally affected by group A streptococcus. There is seasonal increase in the prevalence of group A streptococcus-associated pharyngitis. Streptococcal pharyngitis is most prevalent in winter and early spring with higher incidence of disease observed in crowded population such as school children. Early diagnosis and treatment of group A streptococcal pharyngitis has been shown to reduce the severity of symptoms and further complications such as rheumatic fever and glomerulonephritis. The conventional methods used for identification of group A streptococci depend on isolation and identification of the organism on blood agar plates. These methods usually require 18-24 hours of incubation at 37?C. Such delay in identifying the group A streptococcus has often made physicians to administer therapy without first disclosing the etiological agent. Development of immunologic tests, capable of detecting the group A streptococcal antigen directly from the throat swabs, produced rapid test results employed for better treatment of patients. STREP A test is a rapid immunochromatographic test for the detection of group A streptococci from throat swabs or culture. The accuracy of the test does not depend on the organism viability. Instead, group A strep antigen is extracted directly from the swab and identified using antibodies specific for the group A carbohydrates. We compared rapid test with conventional throat swab in 40 children, who met Centor criteria for streptococcal pharyngitis (absence of cough, high fever, purulent pharyngitis, enlarged and painful cervical lymph nodes). Overall congruence of rapid test and culture was 94%. Test is easy to perform and it is recommended as the first diagnostic test for management of children with streptococcal pharyngitis. In children with negative test, but with characteristics highly suggestive of streptococcal infection, throat culture should be performed.

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