Effect of antibiotic therapy on the clinical course of streptococcal pharyngitis

Randolph, Martin F.; Gerber, Michael A.; DeMeo, Kathleen K.; Wright, Laura

doi:10.1016/s0022-3476(85)80228-6

Cited by 189 publications

(64 citation statements)

References 12 publications

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“…Antibiotic therapy aims at reducing the severity of the symptoms, shortening the course of the disease, reducing infectivity and transmission rates and preventing suppurative (e.g., peritonsillar abscess, cervical lymphadenitis and mastoiditis), as well as non-suppurative complications (e.g., rheumatic fever). [7][8][9][10] It is most beneficial for hastening resolution of symptoms if instituted within the first 2 days of illness. 8,9 In our study, the patients that had a negative RADT and a subsequent positive DNA probe test were of particular interest to us, because these were the strep cases 'missed' by the RADT.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10] It is most beneficial for hastening resolution of symptoms if instituted within the first 2 days of illness. 8,9 In our study, the patients that had a negative RADT and a subsequent positive DNA probe test were of particular interest to us, because these were the strep cases 'missed' by the RADT. Approximately half of these patients were treated before the DNA probe result was available, and half were treated after it was available.…”

Section: Discussionmentioning

confidence: 99%

“…6 When given early in the course of illness, antibiotic therapy can shorten the duration of symptoms, reduce the rate of transmission and prevent suppurative complications (e.g., peritonsillar abscess, cervical lymphadenitis and mastoiditis) and rheumatic fever. [7][8][9][10] In addition, the cost of GABHS pharyngitis is substantial, estimated to be over 1.2 billion dollars per year in adults in 2008. 11 Fever, tonsillar exudate, anterior cervical adenopathy and absence of cough increase the likelihood of GABHS pharyngitis, and the presence or absence of these signs and symptoms are helpful in judging the likelihood of GABHS infection.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Management of Adults with Acute Streptococcal Pharyngitis: Minimal Value for Backup Strep Testing and Overuse of Antibiotics

Nakhoul

Hickner

2012

J GEN INTERN MED

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BACKGROUND: Rapid antigen detection tests (RADT) are commonly used to guide appropriate antibiotic treatment of group A beta-hemolytic streptococcal (GABHS) pharyngitis. In adults, there is controversy about the need for routine backup testing of negative RADT. OBJECTIVE: Estimate the costs and benefits in adults of routine backup testing by DNA Gen-probe of negative RADT (Acceava). DESIGN: Observational follow-up study. PARTICIPANTS: All patients aged 18 years and older visiting a Cleveland Clinic generalist physician in 2009 and 2010 with a visit diagnosis of acute pharyngitis (ICD codes 462, 034.0). MAIN MEASURES: The patients were identified using the Cleveland Clinic Epic Clarity database. We determined the proportion of false negative RADT, antibiotic prescription patterns and rate of serious suppurative complications within 30 days of the office visit. KEY RESULTS: Of 25,130 patients with acute pharyngitis, 19 % had no testing and 81 % were tested. Of the 15,555 patients that had a negative RADT and follow-up DNA probe, 6 % had a positive DNA probe. Of the 953 patients who had a negative RADT and a positive DNA strep probe, 48 % received an antibiotic prescription at the time of the visit and 51 % received an antibiotic prescription after an average of 2.3 days. Only one patient with a negative RADT and no follow-up DNA probe developed a peritonsillar abscess. Overall, of the 15,555 DNA probes performed, management was altered in only 3 % of the patients at a total cost of $1,757,715. Fifty-six percent received an antibiotic while only 19.5 % had a confirmed strep throat diagnosis. CONCLUSIONS: The false negative rate of Acceava RADT for the diagnosis of GABHS pharyngitis was 6 %. We question the benefit of routine DNA probe backup testing in adults because of its substantial cost, an average delay in antibiotic prescribing of over 2 days, and because suppurative complications are very uncommon. We found a high rate of inappropriate antibiotic prescribing.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Management of Adults with Acute Streptococcal Pharyngitis: Minimal Value for Backup Strep Testing and Overuse of Antibiotics

Nakhoul

Hickner

2012

J GEN INTERN MED

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“…Although it has been first debated whether it is worthwhile offering antibiotic for treatment and prevention of acute recurrent pharyngitis since it is simply self-limiting in most cases [5], several studies have confirmed the effectiveness of these prophylactic antibiotic treatment in reducing symptoms, recurrence, socioeconomic burden [38,39] and the risk of complications [22]. Without treatment, pharyngitis may be associated with persistent positive throat cultures for up to 6 weeks in 50% of patients [40].…”

Section: Discussionmentioning

confidence: 99%

Comparative Study of Oral Daily Amoxicillin, Long Acting Intramuscular Penicillin, and Tonsillectomy in Prevention of Recurrent Pharyngitis

Ahmed¹,

Wahsh²,

Ahmed³

2015

Med-Science

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“…По данным мета-анализа, распространенность БГСА-инфекции у детей до 18 лет с острым фарингитом составляет 37% [95% доверительный интервал (confidence interval, CI) [32][33][34][35][36][37][38][39][40][41][42][43]. В младшей возрастной группе частота стрептококкового фарингита меньше и не превышает 24% (95% CI [21][22][23][24][25][26]. Распространенность носительства БГСА у детей без симп томов болезни достигает 12% (95% CI 9-14) [4].…”

Section: Introductionunclassified

Diagnosis and Treatment of Acute Streptococcal Pharyngitis in Children

Куличенко¹

2015

PPh

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ВВЕДЕНИЕЭтиологическим фактором стрептококкового фарин -гита являются бета-гемолитический стрептококк группы А (БГСА), который включает всего один вид -Streptococcus pyogenes. Уже из названия бактерии очевидно, что она вызывает гнойные инфекции. Стрептококковый фарин-гит (в нашей стране приняты также термины «ангина» и «стрептококковый тонзиллит») следует отнести к срав-нительно нетяжелым бактериальным инфекциям, одна-ко он может вызывать серьезные гнойные осложне-ния, такие как перитонзиллярный абсцесс, флегмона шеи, мастоидит, шейный лимфаденит, и инициировать постинфекционный иммунопатологический процесс. Установлена связь между инфекцией S. pyogenes и раз-витием ревматических пороков сердца, острого гломеру-лонефрита, ревматической лихорадки, хореи Сиденгама (неврологические проявления ревматической лихорад-ки), а также обсессивно-компульсивных расстройств и тиков (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus, PANDAS-синдром) [1].Стрептококковый фарингит встречается в любом воз-расте, но наиболее распространен у детей старше 3 лет и подростков: на его долю приходится до 15-30% всех случаев ангины и фарингита [2, 3]. По данным мета-анализа, распространенность БГСА-инфекции у детей до 18 лет с острым фарингитом составляет 37% [95% доверительный интервал (confidence interval, CI) 32-43]. В младшей возрастной группе частота стрептококкового фарингита меньше и не превышает 24% (95% CI 21-26). Распространенность носительства БГСА у детей без симп томов болезни достигает 12% (95% CI 9-14) [4].При отсутствии должного лечения стрептококковый фарингит обычно разрешается самостоятельно через 3-5 сут. Несмотря на противоречивые данные о при-чинно-следственной связи между неадекватно леченым БГСА-фарингитом и развитием осложнений, в настоя-щее время именно их предупреждение является главной целью терапии [5].Обоснование целесообразности терапии стрептококко-вого фарингита вполне рационально, но на практике адек-ватность лечения определяется точностью диагностики БГСА-инфекции. Большинство случаев фарингита (пациен-ты с «красным горлом») обусловлено вирусами, протекает доброкачественно и не требует специфического лечения. S. pyogenes -абсолютный лидер среди возможных бак-териальных возбудителей острого фарингита. Диагностика острого фарингита, таким образом, обычно бывает направ-лена на дифференцирование вирусной и БГСА-инфекции. Антимикробная терапия при вирусном фарингите не при-несет пациенту выздоровления, но может быть полезна при болезни, обусловленной БГСА. Точность этиологиче-ской диагностики крайне важна и для предупреждения

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Effect of antibiotic therapy on the clinical course of streptococcal pharyngitis

Cited by 189 publications

References 12 publications

Management of Adults with Acute Streptococcal Pharyngitis: Minimal Value for Backup Strep Testing and Overuse of Antibiotics

Management of Adults with Acute Streptococcal Pharyngitis: Minimal Value for Backup Strep Testing and Overuse of Antibiotics

Comparative Study of Oral Daily Amoxicillin, Long Acting Intramuscular Penicillin, and Tonsillectomy in Prevention of Recurrent Pharyngitis

Diagnosis and Treatment of Acute Streptococcal Pharyngitis in Children

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