Abstract
Streptococcal pharyngitis is a very common pathology in paediatric age all over the world. Nevertheless there isn't a joint agreement on the management of this condition. Some authors recommend to perform a microbiological investigation in suspected bacterial cases in order to treat the confirmed cases with antibiotics so to prevent suppurative complications and acute rheumatic fever. Differently, other authors consider pharyngitis, even streptococcal one, a benign, self-limiting disease. Consequently they wouldn't routinely perform microbiological tests and, pointing to a judicious use of antibiotics, they would reserve antimicrobial treatment to well-selected cases. It has been calculated that the number of patients needed to treat to prevent one complication after upper respiratory tract infections (including sore throat), was over 4000.Even the use of the Centor score, in order to evaluate the risk of streptococcal infection, is under debate and the interpretation of the test results may vary considerably. Penicillin is considered all over the world as first line treatment, but oral amoxicillin is also accepted and, due to its better palatability, can be a suitable option. Macrolides should be reserved to the rare cases of proved allergy to β-lactams. Cephalosporins can be used in patients allergic to penicillin (with the exception of type I hypersensibility) and have been also proposed to treat the relapses.
Highlights
Acute pharyngitis is defined as an infection of the pharynx and/or tonsils
Streptococcal pharyngitis has a peak incidence in the early school years and it is uncommon before 3 years of age
Clinical manifestations include sore throat and fever with sudden onset, red pharynx, enlarged tonsils covered with a yellow, blood-tinged exudate
Summary
Acute pharyngitis is defined as an infection of the pharynx and/or tonsils. It is a very common pathology among children and adolescents. The other position, followed by UK [19], Scottish [20], Dutch [21] and Belgian [22] authors, considers pharyngitis, even GABHS one, a benign self limiting disease, given to the low incidence of suppurative complications and ARF in developed countries This second idea leads to reserve antibiotics treatment to selected cases, so as to make a judicious use of antibiotics in order to avoid the spread of resistant strains. If clinical and epidemiological features suggest the possibility of GABHS infection, a laboratory test (culture or RADT) should be performed and, in case of positivity, antibacterial treatment should be prescribed to the patient [14]. Competing interests The authors declare that they have no competing interests
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