Throat Cultures

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.

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

PEDIATRICS ◽

10.1542/peds.91.6.1166 ◽

1993 ◽

Vol 91 (6) ◽

pp. 1166-1170 ◽

Cited By ~ 1

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.

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Pharyngitis—Principles of Judicious Use of Antimicrobial Agents

PEDIATRICS ◽

10.1542/peds.101.s1.171 ◽

1998 ◽

Vol 101 (Supplement_1) ◽

pp. 171-174 ◽

Cited By ~ 2

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.

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

Epidemiology and Infection ◽

10.1017/s0950268800050147 ◽

1992 ◽

Vol 109 (2) ◽

pp. 181-189 ◽

Cited By ~ 4

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.

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

PEDIATRICS ◽

10.1542/peds.86.3.457 ◽

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

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

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh04s1039n ◽

2004 ◽

Vol 132 (suppl. 1) ◽

pp. 39-41 ◽

Cited By ~ 1

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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ERYTHROMYCIN PROPIONATE AND POTASSIUM PENICILLIN V IN THE TREATMENT OF GROUP A STREPTOCOCCAL PHARYNGITIS

PEDIATRICS ◽

10.1542/peds.31.1.22 ◽

1963 ◽

Vol 31 (1) ◽

pp. 22-28

Author(s):

Maxwell Stillerman ◽

Stanley H. Bernstein ◽

Martha Smith ◽

Jack D. Gorvoy

Keyword(s):

Relative Effectiveness ◽

Streptococcal Pharyngitis ◽

Group A Streptococci ◽

Cure Rate ◽

Acute Pharyngitis ◽

Penicillin V ◽

Daily Dose ◽

Group A ◽

Potassium Penicillin

The relative effectiveness of erythromycin propionate and K penicillin V in two dosage schedules was evaluated in the treatment of 261 cases of acute pharyngitis from which Group A hemolytic streptococci were recovered from December, 1958, to June, 1959. Erythromycin propionate, in a daily dose of 30 mg/kg up to 1.0 gm, and K penicillin V, in daily doses of 375 mg and 750 mg, were administered orally for 10 days. The adjusted bacterial cure rate was 78% among 86 patients treated with erythromycin, 72% among 102 patients treated with K penicillin V, 375 mg, and 88% among 73 patients treated with K penicillin V, 750 mg. The data indicate that K penicillin V was more effective in eradicating Group A streptococci from the pharynx in a daily dose of 750 mg than 375 mg, and suggest that erythromycin propionate in the dosage used, was less effective than K penicillin V, 750 mg, but equally as effective as K penicillin V, 375 mg daily. The incidence, time of occurrence, and results of retreatments of bacterial relapses are presented, and two possible causes of relapses are considered.

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Significance of Quantitative Salivary Cultures for Group A and Non-group A β-Hemolytic Streptococci in Patients with Pharyngitis and in Their Family Contacts

PEDIATRICS ◽

10.1542/peds.64.6.904 ◽

1979 ◽

Vol 64 (6) ◽

pp. 904-912

Author(s):

Edward L. Kaplan ◽

Robert Couser ◽

Barbara Ballard Huwe ◽

Carolyn Mckay ◽

Lewis W. Wannamaker

Keyword(s):

Antibody Response ◽

Respiratory Tract ◽

Group A Streptococci ◽

Upper Respiratory Tract ◽

C Reactive Protein ◽

Throat Culture ◽

Reactive Protein ◽

Group A ◽

Bona Fide ◽

Upper Respiratory

One hundred ninety-six individuals, 86 with clinically overt pharyngotonsillitis and 110 of their clinically negative contacts were studied to evaluate the sensitivity and the specificity of quantitative saliva cultures for group A β-hemolytic streptococci. We also compared this technique with semiquantitative throat cultures as a means of isolating group A streptococci and of differentiating the streptococcal carrier state from patients with bona fide streptococcal upper respiratory tract infection as defmed by the presence of an antibody response. The data indicate that the throat culture is a more reliable means of identifying group A β-hemolytic streptococci in the upper respiratory tract than is the saliva culture. The converse is true for non-group A β-hemolytic streptococci; the saliva culture is a much better means for isolating these organisms. In individuals positive by both techniques we found good correlation between the degree of positivity of the saliva culture and the degree of positivity of the throat culture. Furthermore, while there was a definite trend for individuals with strongly positive cultures to demonstrate more often an antibody rise in either antistreptolysin O and/or antideoxynibonuclease B—indicating bona fide infection—this relationship was not sufficiently constant to provide a clear differentiation. This study also indicates that discordance (one positive, one negative) of simultaneous duplicate semiquantitative throat cultures is much more common among individuals who do not show an antibody response ("carriers") than among those with an antibody response (bona fide infection). This study confirms our previous observations suggesting that the presence of C-reactive protein in the serum of patients with a positive culture for group A streptococci and clinical signs and symptoms of pharyngitis is often an indication of true streptococcal upper respiratory tract infection, and that even with a positive saliva culture at the initial visit, a negative C-reactive protein is only infrequently (25%) associated with an antibody response.

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Streptococcal pharyngitis in general practice. 2. A note on dual infection and transient urinary abnormalities

Epidemiology and Infection ◽

10.1017/s0950268800050159 ◽

1992 ◽

Vol 109 (2) ◽

pp. 191-197 ◽

Cited By ~ 2

Author(s):

P. M. Higgins

Keyword(s):

General Practice ◽

Clinical Evidence ◽

Dual Infection ◽

Streptococcal Pharyngitis ◽

Microscopic Haematuria ◽

Group A Streptococci ◽

Group A ◽

Post Streptococcal Glomerulonephritis ◽

Urinary Abnormalities

SUMMARYIn an uncompleted study in 1965 microscopic haematuria in the second or third week after acute pharyngitis was found four times more often in patients with either microbiological or clinical evidence of dual infection with both group A streptococci and a virus than in patients with evidence only of infection with group A streptococci.Prospective studies of the role of viruses in the aetiology of transient haematuria and of acute post streptococcal glomerulonephritis are feasible in general practice and would be most productive if concentrated in children 5–9 years of age.

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