Streptococcal Pharyngitis in the General Population. II. The Attack Rate of Rheumatic Fever and Acute Glomerulonephritis in Patients Not Treated with Penicillin

Valkenburg, H. A.; Haverkorn, M. J.; Goslings, W. R. O.; Lorrier, J. C.; Moor, C. E. De; Maxted, W. R.

doi:10.1093/infdis/124.4.348

Cited by 38 publications

(15 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These fi ndings, however, have never been confi rmed in other trials with penicillin, [63][64][65] nor have they be confi rmed in consecutive prospective studies. [66][67][68][69] Almost a half-century ago, an editorial claimed:…”

Section: In T Er Nat Iona L Pha Ry Ngi T Is Guidel Inesmentioning

confidence: 99%

Differences Among International Pharyngitis Guidelines: Not Just Academic

Matthys¹,

Meyere²,

Driel³

et al. 2007

The Annals of Family Medicine

158

105

View full text Add to dashboard Cite

PURPOSE Many countries have national guidelines for the treatment of pharyngitis. We wanted to compare the recommendations and the reported evidence in national guidelines for the management of acute sore throat in adults.METHODS Guidelines were retrieved via MEDLINE and EMBASE and through a Web-based search for guideline development organizations. The content of the recommendations and the underlying evidence were analyzed with qualitative and bibliometric methods. RESULTSWe included 4 North American and 6 European guidelines. Recommendations differ with regard to the use of a rapid antigen test and throat culture and with the indication for antibiotics. The North American, French, and Finnish guidelines consider diagnosis of group A streptococcus essential, and prevention of acute rheumatic fever remains an important reason to prescribe antibiotics. In 4 of the 6 European guidelines, acute sore throat is considered a self-limiting disease and antibiotics are not recommended. The evidence used to underpin these guidelines was different in North America and Europe. North American guidelines cited more North American references than did European guidelines (87.2% vs 48.0%; ods ratio, 4.6-11.9; P <.001).CONCLUSION Although the evidence for the management of acute sore throat is easily available, national guidelines are different with regard to the choice of evidence and the interpretation for clinical practice. Also a transparent and standardized guideline development method is lacking. These fi ndings are important in the context of appropriate antibiotic use, the problem of growing antimicrobial resistance, and costs for the community.

show abstract

Section: In T Er Nat Iona L Pha Ry Ngi T Is Guidel Inesmentioning

confidence: 99%

Differences Among International Pharyngitis Guidelines: Not Just Academic

Matthys¹,

Meyere²,

Driel³

et al. 2007

The Annals of Family Medicine

158

105

View full text Add to dashboard Cite

show abstract

“…Nonetheless, a live mucosal group A streptococcal vaccine poses certain safety concerns that stem from the observation that acute rheumatic fever follows ca. 1 to 3% of untreated episodes of group A streptococcal pharyngitis (22,30,36). Invoking the experience with wild-type group A streptococcal infection that penicillin therapy is highly efficacious in preventing acute rheumatic fever when initiated within 9 days after the onset of pharyngitis (4), we aimed to demonstrate with a high degree of certainty that SP204(1-1) can be eradicated with alacrity when an antibiotic is initiated 5 days after implantation.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Microbiological Responses of Volunteers to Combined Intranasal and Oral Inoculation with a Streptococcus gordonii Carrier Strain Intended for Future Use as a Group A Streptococcus Vaccine

et al. 2005

View full text Add to dashboard Cite

Streptococcus gordonii shows promise as a live mucosal vaccine vector for immunization against respiratory pathogens. In preparation for clinical trials to evaluate S. gordonii engineered to express group A streptococcal M protein antigens, we characterized the responses of 150 healthy volunteers to combined nasal and oral inoculation with approximately 1.5 ؋ 10 9 CFU of SP204(1-1), an S. gordonii strain not bearing vaccine antigens. SP204(1-1) was selected for resistance to streptomycin and 5-fluoro-2-deoxyuridine to distinguish it from indigenous flora. In two antibiotic treatment studies, we performed serial culturing of nose, mouth, and saliva samples from 120 subjects treated with azithromycin beginning 5 days after inoculation to determine whether SP204(1-1) could be rapidly eliminated should safety concerns arise. A natural history study was performed to assess the time until spontaneous eradication in the remaining 30 subjects, who did not receive the antibiotic and who were monitored with repeated culturing for 14 weeks after inoculation. SP204(1-1) was generally well tolerated. Symptoms reported most often within 5 days of inoculation were nasal congestion (36%), headache (30%), and sore throat (19%). The strain was detected by culturing in 98% of subjects. A single dose of azithromycin eliminated colonization in 95% of subjects; all subjects receiving a 5-day course of an antibiotic showed clearance by day 11. Without the antibiotic, 82% of subjects showed spontaneous eradication of the implanted strain within 7 days, and all showed clearance by 35 days. The results of these clinical trials provide encouragement that the use of S. gordonii as a live mucosal vaccine vector is a feasible strategy.

show abstract

“…The quoted sensitivity (26-30%) and specificity (73-80%), however, are low when compared with the “gold standard” of a rise in antistreptolysin O titre 6. The antistreptolysin O titre is probably the best predictor for the presence of group A β haemolytic streptococcus, the most common bacterial pathogen causing sore throat, as the association with definite cases of rheumatic fever and high initial level of antistreptolysin O titre or rise in antistreptolysin O titre is 100% 7. The low predictive value of throat swabs is probably due to a high symptomless carriage rate of group A β haemolytic streptococcus (ranging from 6% to 40%) 7.…”

Section: Is a Throat Swab A Good Diagnostic Test?mentioning

confidence: 99%

“…The antistreptolysin O titre is probably the best predictor for the presence of group A β haemolytic streptococcus, the most common bacterial pathogen causing sore throat, as the association with definite cases of rheumatic fever and high initial level of antistreptolysin O titre or rise in antistreptolysin O titre is 100% 7. The low predictive value of throat swabs is probably due to a high symptomless carriage rate of group A β haemolytic streptococcus (ranging from 6% to 40%) 7. Although antistreptolysin O titre may be a better gold standard, it is not suitable for routine use because of delay, cost, and the inconvenience of serial titres.…”

Section: Is a Throat Swab A Good Diagnostic Test?mentioning

confidence: 99%

“…In trials from the 1950s, however, treatment of exudative tonsillitis with penicillin did reduce the incidence of subsequent rheumatic fever 2. Moreover, patients who have developed complications (either suppurative or non-suppurative) may not have had a preceding sore throat, and of those with prior symptoms, only a minority will seek medical help 7 8…”

Section: What Are the Benefits And Risks Of Prescribing Antibiotics?mentioning

confidence: 99%

See 1 more Smart Citation