%0 Journal Article
%T Streptococcal Pharyngitis: A Prospective Study of Compliance and Complications
%A E. Michael Sarrell
%A Shmuel M. Giveon
%J ISRN Pediatrics
%D 2012
%R 10.5402/2012/796389
%X 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¨C6 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¨C30 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. 1. Introduction Acute pharyngitis is one of the most common infections encountered in primary care clinics. Only 20¨C30% of patients with group A beta hemolytic streptococcus (GABHS) pharyngitis presents with classical symptoms of the disease [1]. Reliance on clinical judgment alone has a poor predictive value and results in 80% to 95% overestimation of disease [2, 3]. Diagnostic strategies for acute GABHS pharyngitis are thus based on epidemiological factors, signs, and symptoms, as well as the result of throat cultures (TCs) [4]. Several studies have shown that the use of throat culture leads to more judicious use of antibiotics [5¨C7]. Physicians prescribe antibiotics for acute pharyngitis as
%U http://www.hindawi.com/journals/isrn.pediatrics/2012/796389/