Identification and Treatment of Group A Beta-Hemolytic Streptococcal Infections: Role of the Pediatrician and the Nurse-Practitioner

Abstract

The risk of rheumatic fever in childhood continues to be high in the United States, especially where crowded living conditions promote epidemic spread of streptococcal pharyngitis. Early identification and appropriate penicillin therapy shorten the acute streptococcal illness and greatly reduce the occurrence of sequelae. Florid disease usually presents no therapeutic dilemma, but a firm scientific basis for definitive diagnosis and treatment of the carrier state, inapparent infection, mild clinical disease, or relapse is lacking. Appreciation of these unresolved issues is helpful in developing practical therapeutic guidelines for physicians and assistants. Public health throat culture programs may provide the initiative for effective community streptococcal control, but centralization of facilities on a large scale may delay institution of therapy because of slow reporting of culture results. Although delay in treatment may engender increased risk of rheumatic fever, institution of appropriate penicillin therapy may prevent rheumatic fever even if started after an untreated streptococcal tonsillitis has run its usual 5 day symptomatic course. Throat cultures are necessary in diagnosis, but clinical judgment must be exercised in initiating penicillin therapy before the culture is reported. The relative morbidity and ultimate mortality of the sequelae to streptococcal disease suggest assignment of national health priority to the development of preventive programs. Utilization of nurse-practitioners or similarly trained medical assistants seems necessary to effective delivery of care in the crowded areas of highest rheumatic fever incidence.