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.

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.

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.

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.

scholarly journals Comparative efficacy and safety of 3-day azithromycin and 10-day penicillin V treatment of group A beta-hemolytic streptococcal pharyngitis in children.

1996 ◽  
Vol 40 (4) ◽  
pp. 1005-1008 ◽  
Author(s):  
L Pacifico ◽  
F Scopetti ◽  
A Ranucci ◽  
M Pataracchia ◽  
F Savignoni ◽  
...  
Keyword(s):  
Clinical Success ◽  
Streptococcal Pharyngitis ◽  
Efficacy And Safety ◽  
Comparative Efficacy ◽  
Once Daily ◽  
Penicillin V ◽  
Oral Regimen ◽  
Beta Hemolytic Streptococcus ◽  
Group A

The efficacy and safety of a 3-day course of azithromycin oral suspension (10 mg/kg of body weight once daily) were compared with those of penicillin V (50,000 U/kg/day in two divided doses) in children aged 3 to 12 years for the treatment of symptomatic pharyngitis caused by the group A beta-hemolytic streptococcus (GABHS). For the 154 evaluable patients, the original infecting strain of GABHS was eliminated at the end of follow-up (34 to 36 days after treatment started) from 67 (85.8%) of 78 penicillin-treated patients and 41 (53.9%) of 76 azithromycin-treated patients (P < 0.0001). Overall clinical success was achieved in 71 (91.0%) of 78 penicillin V-treated patients and 57 (75.0%) of 76 azithromycin-treated patients (P < 0.05). Potential drug-related adverse events were reported for 5.5 and 8.6% of the penicillin V- and azithromycin-treated patients, respectively (P = 0.6). In the present study, a once-daily (10 mg/kg), 3-day oral regimen of azithromycin was as safe as a 10-day course of penicillin but did not represent an effective alternative to penicillin for the treatment of GABHS pharyngitis, even for those children with azithromycin-susceptible strains.

Effectiveness of anti-epidemic measures in tuberculosis clusters in Chisinau municipality

2021 ◽  
pp. 39-44
Author(s):  
Alina Malic ◽  
◽  
Dumitru Batir ◽  
Evelina Lesnic ◽  
Tatiana Osipov ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Positive Culture ◽  
Living Conditions ◽  
High Rate ◽  
Sputum Smear ◽  
Tuberculous Infection ◽  
Clinical Hospital ◽  
Group A ◽  
Epidemiological Situation

The highest risk of the disease is observed among the contacts of the patients with tuberculosis in the clusters with a long-term contact. The aim of the research was to study the particularities of tuberculosis clusters (TC) depending on the degree of epidemiological danger and to assess the eff ectiveness of anti-epidemic measures in these TC. 384 tuberculosis clusters were analyzed in patients with sensitive evolutive tuberculosis admitted for the treatment in the Municipal Clinical Hospital of Phthisiopneumology. According to the criteria for the TB clusters classifi cation, they were divided into 3 groups: 1st group – 279 (72,7%) clusters, 2nd group – 104 (27,1%) and 3rd group – a single (0,2%) cluster. In the 1st group TC children 163 (58.4%) were established; pregnant women were identifi ed in 11 (3.9%) TC and were TB/HIV co-infected cases in 18 (6.5%) TC. Tuberculosis was confi rmed microbiologically by sputum smear in 263 (94.3%) patients. Contacts examination detected 15 children and 7 adults with tuberculosis. In the 2nd group TC the optimal living conditions predominated as a clasifi cation criteria. Positive culture for tuberculosis mycobacteria was identifi ed in 53 (51.0%) patients, and 4 contact from TC were diagnosed with tuberculosis. Conclusion: the high rate of the 1st groups TC showes an unfavorable epidemiological situation, despite the steady decreasing trend of the epidemiological indicators. Optimizing anti-epidemic measures in clusters through the enlargement of the actively investigated groups will contribute to the precocious detection and reducing the transmission of the tuberculous infection.

C-Reactive Protein in Streptococcal Pharyngitis

PEDIATRICS ◽  
1977 ◽  
Vol 60 (1) ◽  
pp. 28-32
Author(s):  
Edward L. Kaplan ◽  
Lewis W. Wannamaker
Keyword(s):  
Streptococcal Infection ◽  
Positive Culture ◽  
Streptococcal Pharyngitis ◽  
Antibody Responses ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Initial Culture ◽  
Group A ◽  
Bona Fide ◽  
Symptomatic Carrier

This study was designed to explore whether the test for C-reactive protein (CRP) is useful in differentiating bona fide streptococcal infection from the symptomatic carrier at the time of the acute visit to the physician. Serial blood samples from 157 children with symptomatic pharyngitis and a positive culture for group A streptococci were analyzed for the presence or absence of CRP. These data were compared with the patients' antibody responses to two streptococcal extracellular antigens (antistreptolysin O and antistreptococcal deoxyribonuclease B). Seventy-eight percent of patients with serologically confirmed streptococcal pharyngitis had a positive CRP test at the initial visit. Conversely, if the CRP test was negative at the acute visit, only about 25% later showed an antibody response. This latter finding held regardless of the degree of positivity of the initial culture, the presence of exudate or adenitis, or the presence of a temperature greater than 38.3 C (101 F) or coryza. These data suggest that the CRP test may be helpful to the clinician, especially if this abnormal protein is absent at the time of the acute visit.

scholarly journals Interlocking intramedullary nailing in comminuted femoral shaft fractures

2012 ◽  
Vol 1 (2) ◽  
pp. 57-63
Author(s):  
Abul Kalan Mohammad ◽  
Ram Kewal Shah ◽  
Awais Syed ◽  
Pradeep Gupta
Keyword(s):  
Intramedullary Nailing ◽  
Femoral Fractures ◽  
Invasive Procedure ◽  
Femoral Shaft ◽  
Short Operative Time ◽  
Medical College ◽  
Almost All ◽  
A Prospective Study

A prospective study of 20 comminuted femoral fractures, open and close, treated with interlocked intramedullary nailing. The mechanical strength of the nail and less invasive procedure has made the procedure preferable. Short Operative time and less blood loss was seen during surgical procedure. Out of 20 cases , 10 cases were taken from Nepal Medical College, Kathmandu and 10 cases from Nobel Medical College, Biratnagar, during years 2009 to 2011, which had been completed at least six months follow up. Almost all cases were relatively free from long term complication. The results were promising .All fractures healed within 6 months.DOI: http://dx.doi.org/10.3126/jonmc.v1i2.7300 Journal of Nobel Medical College (2012), Vol.1 No.2 p.50-56

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 Sojini izoflavoni kot pristop prve izbire pri zdravljenju vazomotoričnih težav v menopavzi

2016 ◽  
Vol 85 (4) ◽  
Author(s):  
Mathias Schmidt ◽  
Karin Arjomand-Wölkart ◽  
Martin H. Birkhäuser ◽  
Andrea R. Genazzani ◽  
Doris M. Gruber ◽  
...  
Keyword(s):  
Red Clover ◽  
Clinical Findings ◽  
Hot Flushes ◽  
High Intake ◽  
Reduced Frequency ◽  
Potential Benefits ◽  
Hormone Sensitive ◽  
Almost All ◽  
Different Sources

The link between higher uptake of isoflavones and a reduced frequency of menopause-related hot flushes were first described in 1992 based on a lower incidence of hot flushes in countries with high dietary soy intake1. Since then, a number of clinical trials with different sources of isoflavones, including soy and red clover, have been performed, and in almost all studies with an appropriate design the outcome was in favour of isoflavone supplementation2. A detailed risk assessment3 revealed that a number of data in humans do not confirm the alleged adverse effect resulting from possible interaction between isoflavones and the hormone-sensitive tissues of the mammary glands, uterus and thyroid. Safety was demonstrated by long-term intake of 150 mg of isoflavones per day, which lasted at least three years. It was also found that a high intake of isoflavones prevented the occurrence of breast cancer4-7. Clinical findings indicate potential benefits of exposure to isoflavones during breast cancer treatment with tamoxifen or anastrozole.

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