Abstract
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 4–6 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 21–30 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.
Highlights
Acute pharyngitis is one of the most common infections encountered in primary care clinics
We located from our computerized data base 107,840 patients, aged 6 months to 18 years, who were examined by their primary care physician for upper respiratory tract infection, tonsillitis, pharyngitis, sore throat, tonsillopharyngitis, neck pain, cervical lymphadenopathy, peritonsillar abscess (PTA), retropharyngeal abscess (RPA), from January 1, 1999 until December 31, 2000
We accessed the charts of 78,473 of these children who were diagnosed with infected throat or one of the differential variants, excluding all children diagnosed as having viral upper respiratory infections. 47,000 of these patients were formally diagnosed with acute pharyngitis or acute tonsillitis and received a prescription for antibiotics, indicating that their physician suspected bacterial disease
Summary
Acute pharyngitis is one of the most common infections encountered in primary care clinics. Physicians prescribe antibiotics for acute pharyngitis as they are concerned that patients with this complaint may be suffering from GABHS infection that if left untreated might develop suppurative complications, such as, tonsillar abscess or nonsuppurative complications, such as, rheumatic fever [6, 8]. Antibiotics, ; confer only minor symptomatic benefits for GABHS sore throat They shorten the duration of symptoms by merely half a day on average [8, 9]. Uncertainty exists concerning the necessity of 10-day antibiotic treatment of group A beta hemolytic streptococcus (GABHS) pharyngitis. 2,000 children aged 6 months to 18 years with sore throat and positive GABHS culture. Recurrence of symptomatic culture positive GABHS pharyngitis, incidence of suppurative, and long-term, regional, nonsuppurative complications of GABHS pharyngitis, over a ten year period. The incidence of complications in our study was not affected by this poor compliance
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