Diagnosis and Treatment of Group a Streptococcal Pharyngitis

Overview

Journal Semin Pediatr Infect Dis

Specialties Infectious Diseases
Pediatrics

Date 2020 Apr 15

PMID 32288448

Citations 2

Authors

Robert R Tanz

Stanford T Shulman

Affiliations

Soon will be listed here.

Abstract

Pharyngitis caused by the group A streptococcus requires accurate diagnosis and timely treatment to prevent acute rheumatic fever. Clinical signs and symptoms often do not distinguish pharyngitis caused by group A streptococci from pharyngitis caused by other microorganisms. Rapid antigen detection or throat culture are recommended for diagnosis except when viral signs and symptoms are prominent. Therapy with penicillin, the drug of choice, is associated with prevention of rheumatic fever, more rapid clinical improvement, and prompt loss of contagiousness. Bacteriologic treatment failure occurs despite universal sensitivity of group A streptococci to penicillin. The cause of treatment failure (and of chronic carriage) remain to be determined. Newer, more expensive antibiotics do not substantially enhance treatment success and need not be prescribed for most patients.

Citing Articles

[Appropriateness of treatment of acute pharyngotonsillitis according to the scientific evidence].

Ochoa Sangrador C, Vilela Fernandez M, Cueto Baelo M, Eiros Bouza J, Inglada Galiana L An Pediatr (Barc). 2003; 59(1):31-40.

PMID: 12887871 PMC: 7129508. DOI: 10.1016/s1695-4033(03)78145-4.

Upper respiratory tract infections.

Jain N, Lodha R, Kabra S Indian J Pediatr. 2002; 68(12):1135-8.

PMID: 11838568 PMC: 7091368. DOI: 10.1007/BF02722930.

References

Lumio J, JAHKOLA M, Vuento R, Haikala O, Eskola J . Diphtheria after visit to Russia. Lancet. 1993; 342(8862):53-4. View

Tanz R, Shulman S, Sroka P, Marubio S, Brook I, Yogev R . Lack of influence of beta-lactamase-producing flora on recovery of group A streptococci after treatment of acute pharyngitis. J Pediatr. 1990; 117(6):859-63. DOI: 10.1016/s0022-3476(05)80122-2. View

Schappert S . National Ambulatory Medical Care Survey: 1990 summary. Adv Data. 1992; (213):1-11. View

Seppala H, Nissinen A, Jarvinen H, Huovinen S, Henriksson T, Herva E . Resistance to erythromycin in group A streptococci. N Engl J Med. 1992; 326(5):292-7. DOI: 10.1056/NEJM199201303260503. View

Denny F . Current problems in managing streptococcal pharyngitis. J Pediatr. 1987; 111(6 Pt 1):797-806. DOI: 10.1016/s0022-3476(87)80191-9. View

Pichichero M, DISNEY F, TALPEY W, Green J, Francis A, Roghmann K . Adverse and beneficial effects of immediate treatment of Group A beta-hemolytic streptococcal pharyngitis with penicillin. Pediatr Infect Dis J. 1987; 6(7):635-43. DOI: 10.1097/00006454-198707000-00004. View

BREESE B, DISNEY F, TALPEY W . PENICILLIN IN STREPTOCOCCAL INFECTIONS; TOTAL DOSE AND FREQUENCY OF ADMINISTRATION. Am J Dis Child. 1965; 110:125-30. DOI: 10.1001/archpedi.1965.02090030135003. View

Brook I . Role of beta-lactamase-producing bacteria in the failure of penicillin to eradicate group A streptococci. Pediatr Infect Dis. 1985; 4(5):491-5. DOI: 10.1097/00006454-198509000-00010. View

Brook I, Yocum P, Shah K . Surface vs core-tonsillar aerobic and anaerobic flora in recurrent tonsillitis. JAMA. 1980; 244(15):1696-8. View

10.

BREESE B, DISNEY F . The accuracy of diagnosis of beta streptococcal infections on clinical grounds. J Pediatr. 1954; 44(6):670-3. DOI: 10.1016/s0022-3476(54)80008-4. View

11.

Chaudhary S, Bilinsky S, Hennessy J, Soler S, Wallace S, Schacht C . Penicillin V and rifampin for the treatment of group A streptococcal pharyngitis: a randomized trial of 10 days penicillin vs 10 days penicillin with rifampin during the final 4 days of therapy. J Pediatr. 1985; 106(3):481-6. DOI: 10.1016/s0022-3476(85)80687-9. View

12.

Dobkin D, Shulman S . Evaluation of an ELISA for group A streptococcal antigen for diagnosis of pharyngitis. J Pediatr. 1987; 110(4):566-9. DOI: 10.1016/s0022-3476(87)80550-4. View

13.

Gastanaduy A, Kaplan E, Huwe B, Mckay C, Wannamaker L . Failure of penicillin to eradicate group A streptococci during an outbreak of pharyngitis. Lancet. 1980; 2(8193):498-502. DOI: 10.1016/s0140-6736(80)91832-2. View

14.

Poses R, Cebul R, Collins M, Fager S . The accuracy of experienced physicians' probability estimates for patients with sore throats. Implications for decision making. JAMA. 1985; 254(7):925-9. View

15.

Lieu T, Fleisher G, Schwartz J . Clinical performance and effect on treatment rates of latex agglutination testing for streptococcal pharyngitis in an emergency department. Pediatr Infect Dis. 1986; 5(6):655-9. DOI: 10.1097/00006454-198611000-00011. View

16.

Gerber M, RANDOLPH M, Martin N, Rizkallah M, Cleary P, Kaplan E . Community-wide outbreak of group G streptococcal pharyngitis. Pediatrics. 1991; 87(5):598-603. View

17.

Schwartz B, Fries S, Fitzgibbon A, Lipman H . Pediatricians' diagnostic approach to pharyngitis and impact of CLIA 1988 on office diagnostic tests. JAMA. 1994; 271(3):234-8. View

18.

Pichichero M, Margolis P . A comparison of cephalosporins and penicillins in the treatment of group A beta-hemolytic streptococcal pharyngitis: a meta-analysis supporting the concept of microbial copathogenicity. Pediatr Infect Dis J. 1991; 10(4):275-81. DOI: 10.1097/00006454-199104000-00002. View

19.

Grahn E, Holm S . The effect of penicillin on bacterial interference in vivo. Scand J Infect Dis. 1987; 19(3):353-9. DOI: 10.3109/00365548709018482. View

20.

BREESE B, DISNEY F, TALPEY W . The prevention of type specific immunity to streptococcal infections due to the therapeutic use of penicillin. Occurrence of second attacks due to the same type of group A hemolytic streptococci. Am J Dis Child. 1960; 100:353-9. DOI: 10.1001/archpedi.1960.04020040355007. View