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.

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 Streptococcal Pharyngitis: A Prospective Study of Compliance and Complications

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
E. Michael Sarrell ◽  
Shmuel M. Giveon
Keyword(s):  
Positive Culture ◽  
Treated Group ◽  
Streptococcal Pharyngitis ◽  
Clinical Findings ◽  
Cervical Lymphadenitis ◽  
Beta Hemolytic Streptococcus ◽  
Group A ◽  
Almost All ◽  
A Prospective Study

Background. Uncertainty exists concerning the necessity of 10-day antibiotic treatment of group A beta hemolytic streptococcus (GABHS) pharyngitis. Objective. To assess the incidence of GABHS recurrence and suppurative and nonsuppurative complications in relation to compliance. Methods. (Design). Prospective cohort observational study. (Subjects). 2,000 children aged 6 months to 18 years with sore throat and positive GABHS culture. (Main Outcome Measures). Recurrence of symptomatic culture positive GABHS pharyngitis, incidence of suppurative, and long-term, regional, nonsuppurative complications of GABHS pharyngitis, over a ten year period. Results. 213 (11%) of the children received no treatment. Most children received antibiotics for only 4–6 days (in correlation with the duration of fever, which in most cases lasted up to 3 days). Three hundred and six (15.3%) children had clinically diagnosed recurrent tonsillopharyngitis; 236 (12.3%) had positive GABHS findings within 10 to 14 days and thirty-four (1.7%) within 21–30 days after the index positive GABHS culture. The remaining 1.3% had no positive culture despite the clinical findings. Almost all recurrences [236 (11.6%)] occurred within 14 days and 156 (7.6%) in the fully treated group. The presence of fever during the first 3 days of the disease was the most significant predictor for recurrence. Other predictors were the age younger than 6 years and the presence of cervical lymphadenitis. No increase in the incidence of nonsuppurative or suppurative complications was noted during the 10-year follow-up period, compared to the past incidence of those complications in Israel. Conclusions. Our data suggests that the majority of children discontinue antibiotics for GABHS tonsillopharyngitis a day or two after the fever subsides. The incidence of complications in our study was not affected by this poor compliance.

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.

scholarly journals The Cape Town Clinical Decision Rule for Streptococcal Pharyngitis in Children

2017 ◽  
Vol 36 (3) ◽  
pp. 250-255 ◽  
Author(s):  
Mark E. Engel ◽  
Karen Cohen ◽  
Ronald Gounden ◽  
Andre P. Kengne ◽  
Dylan Dominic Barth ◽  
...  
Keyword(s):  
Decision Rule ◽  
Cape Town ◽  
Clinical Decision ◽  
Streptococcal Pharyngitis ◽  
Clinical Decision Rule

A clinical decision rule for management of streptococcal pharyngitis in low-resource settings

2007 ◽  
Vol 94 (8) ◽  
pp. 1038-1042 ◽  
Author(s):  
Mark C Steinhoff ◽  
Christa Fischer Walker ◽  
Anne W Rimoin ◽  
Hala S Hamza
Keyword(s):  
Decision Rule ◽  
Clinical Decision ◽  
Streptococcal Pharyngitis ◽  
Clinical Decision Rule ◽  
Low Resource Settings ◽  
Low Resource

scholarly journals Evaluation of the WHO clinical decision rule for streptococcal pharyngitis

2005 ◽  
Vol 90 (10) ◽  
pp. 1066-1070 ◽  
Author(s):  
A W Rimoin ◽  
H S Hamza ◽  
A Vince ◽  
R Kumar ◽  
C F Walker ◽  
...  
Keyword(s):  
Decision Rule ◽  
Clinical Decision ◽  
Streptococcal Pharyngitis ◽  
Clinical Decision Rule

Antibiotic Susceptibility Evaluation of Bacterial Agents Causing Infection in Children with Acute Tonsillopharyngitis

2020 ◽  
Vol 20 ◽  
Author(s):  
Hamidreza Sherkatolabbasieh ◽  
Majid Firouzi ◽  
Shiva Shafizadeh ◽  
Iman Amiri
Keyword(s):  
Sore Throat ◽  
Predictive Value ◽  
Positive Culture ◽  
Clinical Score ◽  
Streptococcal Pharyngitis ◽  
Diffusion Method ◽  
Disk Diffusion Method ◽  
Cross Sectional ◽  
Clinical Sensitivity ◽  
Group A

Background: The aim of this study is to evaluate the prevalence of group A beta-hemolytic pharyngitis by assessing the outcome of the culture and the resistance and sensitivity of group A beta hemolytic streptococcus to antibiotics. Methods: This cross-sectional study was conducted on 170 patients, aged 3-15 years, referred to the clinic with complaints of sore throat. Patients’ history was collected and physical examination was performed and were score based on clinical findings. Patients with other underlying pathologies and those taking antibiotics prior to the study were excluded from our study. Antimicrobial susceptibility test was performed by disk diffusion method against cephalexin, cefazolin, erythromycin and amoxicillin. Results: A total of 170 patients were reported with sore throat. Patients with positive culture results were 60% male and 40% female. Amoxicillin resistance was the greatest (5%) in the culture. All isolated bacteria were sensitive to amoxicillin, cephalexin, cefazolin and erythromycin. Patients with McIssac score ≥ 6 showed clinical sensitivity 75% specificity 61% negative predictive value 94.8% and positive predictive value 20.3% for Group A beta-hemolytic streptococcal pharyngitis. Conclusion: The results showed the higher the clinical score, the greater the chance of positive throat culture.

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