Nowa wersja platformy, zawierająca wyłącznie zasoby pełnotekstowe, jest już dostępna.
Przejdź na


Preferencje help
Widoczny [Schowaj] Abstrakt
Liczba wyników
2013 | 8 | 6 | 713-719
Tytuł artykułu

Management of acute streptococcal pharyngitis: still the subject of controversy

Treść / Zawartość
Warianty tytułu
Języki publikacji
Although most cases of acute pharyngitis are viral in origin, antibiotics are overused in its treatment. Streptococcus pyogenes (group A streptococcus, GAS), the principal bacterial pathogen of acute sore throat, is responsible for merely 5–30% of cases. Moreover, GAS pharyngitis is currently the only commonly occurring form of acute pharyngitis for which antibiotic therapy is definitely indicated. Therefore the differentiation between GAS pharyngitis and that of viral etiology is crucial. Accordingly, scientific societies as well as respected advisory bodies in Europe and North America, issued guidelines for the management of acute pharyngitis with the aim of minimizing unnecessary antibiotic prescriptions in its treatment. The aim of this review work is to confront the state of the art in acute GAS pharyngitis diagnosis and treatment with different approaches to its management represented by current European and North American guidelines. Although based on scientific evidence, international guidelines differ substantially in opinions whether GAS pharyngitis diagnosis should be based on microbiological testing, clinical algorithm or a combination of both. On the other hand, some European guidelines consider GAS pharyngitis to be a mild, self-limiting disease that does not require a specific diagnosis or antimicrobial treatment except in high-risk patients. There is an agreement among guidelines that if antibiotic therapy is indicated, phenoxymethyl penicillin should be the drug of choice to treat GAS pharyngitis.

Opis fizyczny
  • Medical Microbiology Department, Medical University of Lublin, ul. Chodźki 1, 20-093, Lublin, Poland,
  • [1] Wessels MR. Clinical practice. Streptococcal pharyngitis. N Engl J Med., 2011, 364, 648–655[Crossref]
  • [2] Stjernquist-Desatnik A, Orrling A. Pharyngotonsillitis. Periodontol. 2000, 2009, 49: 140–150[Crossref]
  • [3] Brahmadathan KN, Gladstone P. Microbiological diagnosis of streptococcal pharyngitis: lacunae and their implications. Indian J Med Microbiol., 2006, 24, 92–96[Crossref]
  • [4] Fretzayas A, Moustaki M, Kitsiou S, Nychtari G, Nicolaidou P. The clinical pattern of group C streptococcal pharyngitis in children. J Infect Chemother., 2009, 15, 228–232[Crossref]
  • [5] Tiemstra J, Miranda RLF. Role of non-group A streptococci in acute pharyngitis. J Am Board Fam Med., 2009, 22, 663–669[Crossref]
  • [6] Lindbaek M, Høiby EA, Lermark G, Steinsholt IM, Hjortdahl P. Clinical symptoms and signs in sore throat patients with large colony variant beta-haemolytic streptococci groups C or G versus group A. Br J Gen Pract., 2005, 55, 615–619
  • [7] Hryniewicz W, Ozorowski T, Radzikowski A, Zielonka TM, Albrecht P, Lukas W et al. Rekomendacje postępowania w pozaszpitalnych zakażeniach układu oddechowego 2010. (in Polish)
  • [8] Chazan B, Shaabi M, Bishara E, Colodner R, Raz R. Clinical predictors of streptococcal pharyngitis in adults. Isr Med Assoc J., 2003, 5, 413–415
  • [9] Barash J. Group A streptococcal throat infection - to treat or not to treat? Acta Paediatr., 2009, 98, 434–436[Crossref]
  • [10] Bisno AL, Peter GS, Kaplan EL. Diagnosis of strep throat in adults: are clinical criteria really good enough? Clin Infect Dis., 2002, 35, 126–129[Crossref]
  • [11] Moro ML, Marchi M, Gagliotti C, Mario SD, Resi D, “Progetto bambini a antibiotici [ProBA]” Regional Group. Why do paediatricians prescribe antibiotics? Result of an Italian regional project. BMC Pediatr 2009, 9, 69.[Crossref]
  • [12] Nascimento-Carvalho CM. Outpatient antibiotic therapy as a predisposing factor for bacterial resistance: a rational approach to airway infections. J Pediatr (Rio J)., 2006, 82(5 Suppl), S146-S152 [Crossref]
  • [13] Panasiuk L, Lukas W, Paprzycki P, Verheij T, Godycki-Ćwirko M, Chlabicz S. Antibiotics in the treatment of upper respiratory tract infections in Poland. Is there any improvement? J Clin Pharm Ther., 2010, 35, 665–669[Crossref]
  • [14] Goossens H, Ferech M, Stichele RV, Elseviers M, ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a crossnational database study. Lancet., 2005, 365, 579–587
  • [15] Fernández González N, Herrero-Morín JD, Solís Sánchez G, Pérez Méndez C, Molinos Norniella C, Pardo de la Vega R et al. Variability of antibiotic treatment in paediatric acute pharyngotonsillitis in Asturias, Spain. Arch Argent Pediatr., 2012, 110, 207–213 (in Spanish)[Crossref]
  • [16] Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012, 55, 1279–1282.[Crossref]
  • [17] ESCMID Sore Throat Guideline Group, Pelucchi C, Grigoryan L, Galeone C, Esposito S, Huovinen P, Little P et al. ESCMID guideline for the management of acute sore throat. Clin Microbiol Infect., 2012, 18(Suppl. 1), 1–28[Crossref]
  • [18] Chiappini E, Principi N, Mansi N, Serra A, De Masi S, Camaioni A et al; Italian Panel on the Management of Pharyngitis in Children. Management of acute pharyngitis in children: summary of the Italian National Institute of Health guidelines. Clin Ther., 2012, 34, 1442–1458[Crossref]
  • [19] British Columbia Ministry of Science. Sore throat diagnosis and management. 2003.
  • [20] Systemic antibiotic treatment in upper and lower respiratory tract infections: official French guidelines. Agence Française de Sécurité Sanitaire des Produits de Santé. Clin Microbiol Infect., 2003, 9, 1162–1178
  • [21] National Guideline Clearinghouse. Finnish Medical Society Duodecim. Tonsillitis and pharyngitis in children 2007.
  • [22] National Institute for Health and Clinical Excellence. Respiratory tract infections - antibiotic prescribing. Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. NICE clinical guideline 69. 2008.
  • [23] Scottish Intercollegiate Guidelines Network. Management of sore throat and indication for tonsillectomy. A national clinical guideline 2010.
  • [24] Starreveld JS, Zwart S, Boukes FS, Wiersma T, Goudswaard AN. Summary of the practice guideline “Sore throat” (second revision) from the Dutch College of General Practitioners. Ned Tijdschr Geneeskd., 2008, 152, 431–435 (in Dutch)
  • [25] Chevalier P, De Sutter A. Guide belge des traitements anti-infectieux en pratique ambulatoire. Belgian Antimicrobial Policy Coordination Committee. 2008. (in French)
  • [26] Snow V, Mottur-Pilson C, Cooper RJ, Hoffmann JR; American Academy of Family Physicians; American College of Physicians-American Society of Internal Medicine; Centers for Disease Control. Principles of appropriate antibiotic use for acute pharyngitis in adults. Ann Intern Med., 2001, 134, 506–508[Crossref]
  • [27] Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST et al. Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation 2009, 119, 1541–1551[Crossref]
  • [28] Piñeiro Pérez R, Hijano Bandera F, Álvez González F, Fernández Landaluce A, Silva Rico JC, Pérez Cánovas C et al. Consensus document on the diagnosis and treatment of acute tonsillopharyngitis. An Pediatr (Barc)., 2011, 75, 342.e1–13 (in Spanish)
  • [29] Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strep throat in adults in the emergency room. Med Decis Making., 1981, 1, 239–346[Crossref]
  • [30] McIsaac WJ, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ., 1998, 158, 75–83
  • [31] Breese BB. A simple scorecard for the tentative diagnosis of streptococcal pharyngitis. Am J Dis Child., 1977, 131, 514–517
  • [32] Attia MW, Zaoutis T, Klein JD, Meier FA. Performance of a predictive model for streptococcal pharyngitis in children. Arch Pediatr Adolesc Med., 2001, 155, 687–691[Crossref]
  • [33] Walsh BT, Bookheim WW, Johnson RC, Tompkins RK. Recognition of streptococcal pharyngitis in adults. Arch Intern Med., 1975, 135, 1493–1497[Crossref]
  • [34] Aalbers J, O’Brien KK, Chan WS, Falk GA, Teljeur C, Dimitrov BD et al. Predicting streptococcal pharyngitis in adults in primary care: a systemic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score. BMC Medicine 2011, 9:67[Crossref]
  • [35] Shaikh N, Swaminathan N, Hooper EG. Accuracy and precision of the signs and symptoms of streptococcal pharyngitis in children: a systematic review. J Pediatr., 2012, 160, 487–493[Crossref]
  • [36] Ebell MH, Smith MA, Barry HC, Ives K, Carey M. The rational clinical examination. Does this patient have strep throat? JAMA., 2000, 284, 2912–2918[Crossref]
  • [37] McIsaac WJ, Kellner JD, Aufricht P, Vanjaka A, Low DE. Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA., 2004, 291, 1587–1595[Crossref]
  • [38] Gerber MA, Shulman ST. Rapid diagnosis of pharyngitis caused by group A streptococci. Clin Microbiol Rev., 2004, 17, 571–580[Crossref]
  • [39] van der Veen EL, Sanders EAM, Videler WJM, van Staaij BK, van Benthem PPG, Schilder AGM. Optimal site for throat culture: tonsillar surface versus posterior pharyngeal wall. Eur Arch Otorhinolaryngol., 2006, 263, 750–753[Crossref]
  • [40] Johansson L, Månsson NO. Rapid test, throat culture and clinical assessment in the diagnosis of tonsillitis. Fam Pract., 2003, 20, 108–111[Crossref]
  • [41] Lasseter GM, McNulty CAM, Hobbs FDR, Mant D, Little P on behalf of the PRISM investigators. In vitro evaluation of five rapid antigen detection tests for group A beta-haemolytic streptococcal sore throat infections. Fam Pract., 2009, 26: 437–444[Crossref]
  • [42] Ruiz-Aragón J, Rodrígues López R, Molina Linde JM. Evaluation of rapid methods for detecting Streptococcus pyogenes. Systemic review and meta-analysis. An Pediatr (Barc)., 2010, 72, 391–402 (in Spanish)[Crossref]
  • [43] Tanz RR, Gerber MA, Kabat W, Rippe J, Seshadri R, Shulman ST. Performance of a rapid antigen-detection test and throat culture in community pediatric offices: implications for management of pharyngitis. Pediatrics., 2009, 123: 437–444[Crossref]
  • [44] Edmonson MB, Farwell KR. Relationship between the clinical likelihood of group A streptococcal pharyngitis and the sensitivity of a rapid antigen-detection test in a pediatric practice. Pediatrics., 2005, 115, 280–285[Crossref]
  • [45] Baltimore RS. Re-evaluation of antibiotic treatment of streptococcal pharyngitis. Curr Opin Pediatr., 2010, 22: 77–82[Crossref]
  • [46] Kaplan EL. The group A streptococcal upper respiratory tract carrier state: an enigma. J Pediatr., 1980, 97, 337–345[Crossref]
  • [47] Gerber MA. Diagnosis and treatment of pharyngitis in children. Pediatr Clin North Am., 2005, 52, 729–747[Crossref]
  • [48] Shulman ST, Gerber MA. So what’s wrong with penicillin for strep throat? Pediatrics., 2004, 113: 1816–1819[Crossref]
  • [49] Bisno AL. Are cephalosporins superior to penicillin for treatment of acute streptococcal pharyngitis? Clin Infect Dis., 2004, 38, 1535–1537[Crossref]
  • [50] Casey JR. Selecting the optimal antibiotic in the treatment of group A beta-hemolytic streptococci pharyngitis. Clin Pediatr., 2007, 46(4 suppl), 25S–35S[Crossref]
  • [51] Kaplan EL, Johnson DR. Unexplained reduced microbiological efficacy of intramuscular benzathine penicillin G and of oral penicillin V in eradication of group A streptococci from children with acute pharyngitis. Pediatrics., 2001, 108, 1180–1186[Crossref]
  • [52] Casey JR, Pichichero ME. Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children. Pediatrics., 2004, 113, 866–882[Crossref]
  • [53] Casey JR, Pichichero ME. Meta-analysis of cephalosporins versus penicillin for treatment of group A streptococcal tonsillopharyngitis in adults. Clin Infect Dis., 2004, 38, 1526–1534[Crossref]
  • [54] Gerber MA, Tanz RR, Kabat W, Bell GL, Siddiqui PN, Lerer TJ et al. Potential mechanisms for failure to eradicate group A streptococci from the pharynx. Pediatrics., 1999, 104(4 Pt 1): 911–917[Crossref]
  • [55] Hoye S, Frich J, Lindbaek M. Delayed prescribing for upper respiratory tract infections: a qualitative study of GP’s views and experiences. Br J Gen Pract., 2010, 60, 907–912[Crossref]
  • [56] Centor RM, Allison JJ, Cohen SJ. Pharyngitis management: defining the controversy. J Gen Intern Med., 2007, 22, 127–130[Crossref]
  • [57] Clegg HW, Ryan AG, Dallas SD, Kaplan EL, Johnson DR, Norton HJ et al. Treatment of streptococcal pharyngitis with once-daily compared with twice-daily amoxicillin: a noninferiority trial. Pediatr Infect Dis J., 2006, 25, 761–767[Crossref]
  • [58] Lennon DR, Farrell E, Martin DR, Stewart JM. Once-daily amoxicillin versus twice-daily penicillin V in group A beta-hemolytic streptococcal pharyngitis. Arch Dis Child. 2008, 93, 474–478[Crossref]
  • [59] Gracia M, Díaz C, Coronel P, Gimeno M, García-Rodas R, Rodríguez-Cerrato V et al. Antimicrobial susceptibility of Streptococcus pyogenes in central, eastern and baltic European countries, 2005 to 2006: the cefditoren surveillance program. Diagn Microbiol Infect Dis., 2009, 64: 52–56[Crossref]
  • [60] Tanz RR, Shulman ST, Shortridge VD, Kabat W, Kabat K, Cederlund E et al.; North American Streptococcal Pharyngitis Surveillance Group. Community-based surveillance in the United States of macrolide-resistant pediatric pharyngeal group A streptococci during 3 respiratory disease seasons. Clin Infect Dis., 2004, 39, 1794–1801
Typ dokumentu
Identyfikator YADDA
JavaScript jest wyłączony w Twojej przeglądarce internetowej. Włącz go, a następnie odśwież stronę, aby móc w pełni z niej korzystać.