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Welcome to the Strep Throat
File
Patients all over the world
have used the information in The Strep Throat File since 1992,
when the Center for Current Research—one of the first 80
companies on the Internet—was founded. Our highly trained
researchers (all of whom hold Ph.D.s) have searched the advanced
medical database at the National Library of Medicine and compiled
a comprehensive collection of research descriptions on Strep
Throat and its care.
As you will see, the following research descriptions detail the
findings published in the most respected journals in the field.
Because the research descriptions are written in medical terms,
most people will bring all or parts of the Strep Throat File
to their doctor for further explanation and discussion. Often
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information that could be useful in planning a successful course
of treatment and prevention. Note that the titles of the journals
are abbreviated according to the National Library of Medicine's
format; your doctor can provide the full title if you need it.
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the information fosters better health.
Sincerely,
Gregory A. Fraser, Ph.D.
Director of Research
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is provided for your education. It should not be relied upon for
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Previous Strep Throat
Research: 2002-2006
The
Strep Throat
File also contains summaries of past
research that has shown promise and may still be standard
practice among many physicians.
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research findings on Strep
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Latest Research on Strep Throat
J Am Coll Health. 2008 May-Jun;56(6):657-63.
The association between mental health and acute infectious
illness among a national sample of 18- to 24-year-old college students.
Adams TB, Wharton CM, Quilter L, Hirsch T.
Department of Exercise and Wellness, Arizona State University, Gilbert, AZ, USA.
drtroy@cox.net
Poor mental health is associated with physical illness, but this association is
poorly characterized among college students. OBJECTIVE AND PARTICIPANTS: Using
American College Health Association-National College Health Assessment data, the
authors characterized poor mental health (depression, anxiety, negative affect)
and examined the relationship between poor mental health and acute infectious
illnesses (bronchitis, ear infection, sinusitis, strep throat) among
47,202 US college students. METHODS: The authors used frequency and
cross-tabulation analyses to characterize mental health and determine univariate
associations among variables. They used binary logistic regression to determine
the association between poor mental health and acute infectious illness,
controlling for research-derived covariates. RESULTS: The prevalence of acute
infectious illness ranged from 8% to 29%. The prevalence of anxiety and
depression ranged from 12% to 20%, respectively. Depression, anxiety, and
exhaustion were associated with acute infectious illness across all dependent
measures, with odds ratios ranging from .56 to .91. CONCLUSIONS: Poor mental
health is associated with acute infectious illness among college students.
-----
Antimicrob Agents Chemother. 2008 Mar 10 [Epub ahead of print]
Pharmacodynamic Analysis and Clinical Trial of Amoxicillin
Sprinkle QD for 7 Days Compared to Penicillin VK QID for 10 Days in the
Treatment of Tonsillopharyngitis due to Streptococcus Pyogenes in Children.
Pichichero ME, Casey JR, Block SL, Guttendorf R, Flanner H, Markowitz D, Clausen
S.
Professor of Microbiology and Immunology, Pediatrics and Medicine, University of
Rochester School of Medicine and Dentistry; Elmwood Pediatric Group, Rochester,
New York; Kentucky Pediatric Research, Bardstown, Kentucky; MiddleBrook
Pharmaceuticals, Inc, Germantown, MD.
An a priori pharmacokinetic/pharmacodynamic (PK/PD) target of 40% daily time
above the minimum inhibitory concentration (T >MIC; based on the literature
reported MIC90 of 0.06microg/mL for S. pyogenes) was shown to be achievable in a
phase 1 study of 23 children with a once daily (QD) pulsatile-release,
multiparticulate formulation of amoxicillin sprinkle. The daily T>MIC achieved
by the QD amoxicillin sprinkle formulation was comparable to four times daily (QID)
penicillin VK suspension. An investigator-blind, randomized, parallel-group,
multicenter study was then undertaken involving 579 children age 6 months to 12
years old with acute streptococcal tonsillopharyngitis. Children were randomized
1:1 to receive either the amoxicillin sprinkle (475 mg for ages 6 months to 4
years, 775 mg for ages 5 to 12 years) QD for 7 days or penicillin VK 10 mg/kg
QID for 10 days (up to the maximum dose of 250 mg QID). Unexpectedly,
bacteriological eradication at the test-of-cure for the amoxicillin sprinkle was
65.3% (132/202) and for penicillin VK was 68.0% (132/194) (95% confidence
interval: -12.0%, 6.6%). Thus, neither antibiotic regimen met the minimum
criterion standard of >/=85% eradication ordinarily required by the US FDA for
first line treatment of tonsillopharyngitis due to S. pyogenes. Subgroup
analyses across demographic characteristics, current infection characteristics
and by age/weight categories were consistent with the primary efficacy result.
The clinical cure rates for amoxicillin sprinkle and penicillin VK were 86.1%
(216/251) and 91.9% (204/222), respectively (95% confidence interval: -11.6%,
-0.4%). A post hoc PD analysis suggested that a requirement for 60% daily
T>MIC90 more accurately predicted the observed high failure rates for
bacteriologic eradication with the studied amoxicillin sprinkle and penicillin
VK suspension. Based on literature reported association between longer treatment
courses and maximal bacterial eradication rates, an alternative composite PK/PD
target taking into consideration duration of therapy, total T>MIC, was
considered and provides an alternative explanation for the observed failure rate
of amoxicillin sprinkle.
-----
Arch Dis Child. 2008 Mar 12 [Epub ahead of print]
Once-daily Amoxicillin versus Twice-daily Penicillin V in Group A
{beta}-Hemolytic Streprococcus Pharyngitis.
Lennon DR Fracp, Farrell E Mhsc, Martin DR Phd, Stewart JM Msc.
University of Auckland, New Zealand.
Background: Rheumatic fever is a preventable chronic disease preceded by group A
beta-hemolytic streptococcus (GABHS). OBJECTIVE: To test the non-inferiority of
once-daily (QD) oral amoxicillin to the recommended twice-daily (BID) oral
penicillin V in GABHS pharyngitis. DESIGN: Randomised non-inferiority trial.
SETTING: School-based clinic in New Zealand. Patients: Children presenting with
GABHS pharyngitis. INTERVENTIONS: Children were randomised to oral amoxicillin
1500mg BID (or 750mg if bodyweight was </=30kg) or to oral penicillin V 500mg QD
(or 250mg if bodyweight was </=20kg) for 10 days. Observed medication and
weekend diary cards were used to monitor adherence. OUTCOME: Eradication of
GABHS, determined with follow-up throat cultures on days 3-6, 12-16 and 26-36.
GABHS isolates were serotyped to distinguish bacteriologic treatment failures
(and relapses) from new acquisitions. Non-inferiority was defined as an upper
95% confidence limit (CL) for the difference in success of eradication in the
amoxicillin and penicillin V treatment groups of </=10%. RESULTS: 353 children
with positive throat swabs for GABHS were randomised to amoxicillin (n=177) or
penicillin V (n=176). The upper 95% CL for the differences in positive cultures
between the antibiotics was 4.9% at days 3-6, 6.5% at days 12-16 and 8.5% at
days 26-36. Treatment failures (including relapses) occurred at each visit in
5.8%, 12.7% and 10.7% of amoxicillin recipients and 6.2%, 11.9% and 11.3% of
penicillin V recipients respectively. No significant differences in resolution
of symptoms were noted between treatment groups. CONCLUSION: In this
adequately-powered study, once-daily oral amoxicillin is not inferior to
twice-daily penicillin V for the treatment and eradication of GABHS in children
with pharyngitis.
-----
Clin Ther. 2008 Jan;30(1):158-63.
How Connecticut primary care physicians view treatments for
streptococcal and nonstreptococcal pharyngitis.
Feder HM Jr, Collins M.
University of Connecticut Health Center, Farmington, Connecticut; Connecticut
Children's Medical Center Hartford, Connecticut.
Background: Inappropriate antibiotic treatment of respiratory infections has
been reported to be common; however, the specifics of this inappropriate
treatment are not completely defined. Objective: The aim of this study was to
gather data to determine whether physicians consider the national guidelines of
treating group A B-hemolytic streptococci (GABHS) pharyngitis with penicillin
(BID or TID) and not using antibiotics to treat nonstreptococcal pharyngitis.
Methods: In this pilot survey, a 1-page questionnaire was sent to a random
sample of Connecticut primary care physicians (PCPs) that included emergency
physicians, family physicians, internists, and pediatricians. Two short
hypothetical scenarios were presented: (1) an untreated male patient aged 18
years (who is not penicillin allergic) was seen the day before with fever and
pharyngitis. He returns because he is still symptomatic and his throat culture (TC)
is positive for GABHS; and (2) same scenario but this second patient's TC is
negative for GABHS. Physicians were asked how they would treat the patients in
both scenarios. Results: Of the 642 (representing ~15% of all Connecticut PCPs)
questionnaires sent, 386 (60%) were returned. Seventy-five of the responding
physicians had not seen patients with pharyngitis within the last year and were
excluded; the following results were from 311 physicians. Scenario 1: 191 of 311
physicians (61%) indicated a willingness to treat the GABHS with penicillin.
Pediatricians were significantly less likely, compared with the other PCPs, to
prescribe penicillin (P = 0.01) in this scenario. Seventy-seven of the 191
physicians (40%) indicated a willingness to prescribe the penicillin QID. Seven
PCPs who responded to scenario 1 did not respond to scenario 2. Scenario 2: 98
of the 304 physicians (32%) indicated a willingness to prescribe antibiotics for
the patient with no: streptococcal pharyngitis. Pediatricians were signif cantly
less likely, compared with the other PCPs, prescribe antibiotics for the patient
with nonstreptscoccal pharyngitis in the second scenario (P < 0.001 Conclusions:
This pilot survey found that 61~ of Connecticut PCPs might treat GABHS with
penicill according to existing guidelines although the pen cillin might be
prescribed QID instead of the recor mended BID or TID. Thirty-two percent of
these PC] reported they would use antibiotics to treat non-GABH pharyngitis.
-----
Am Fam Physician. 2008 Jan 15;77(2):199-202. Summary for patients in:
Am Fam Physician. 2008 Jan 15;77(2):209.
Peritonsillar abscess.
Galioto NJ.
Broadlawns Medical Center, Des Moines, Iowa 53104, USA. ngalioto@broadlawns.org
Peritonsillar abscess remains the most common deep infection of the head and
neck. The condition occurs primarily in young adults, most often during November
to December and April to May, coinciding with the highest incidence of
streptococcal pharyngitis and exudative tonsillitis. A peritonsillar abscess is
a polymicrobial infection, but Group A streptococcus is the predominate
organism. Symptoms generally include fever, malaise, sore throat, dysphagia, and
otalgia. Physical findings may include trismus and a muffled voice (also called
"hot potato voice"). Drainage of the abscess, antibiotics, and supportive
therapy for maintaining hydration and pain control are the foundation of
treatment. Antibiotics effective against Group A streptococcus and oral
anaerobes should be first-line therapy. Steroids may be helpful in reducing
symptoms and speeding recovery. To avoid potential serious complications, prompt
recognition and initiation of therapy is important. Family physicians with
appropriate training and experience can diagnose and treat most patients with
peritonsillar abscess. (Am Fam Physician.
-----
Otolaryngol Head Neck Surg. 2007 Dec;137(6):851-857.
Systematic review of factors contributing to penicillin treatment
failure in Streptococcus pyogenes pharyngitis.
Pichichero ME, Casey JR.
University of Rochester Medical Center, Rochester, NY 14642, USA.
Michael_pichichero@urmc.rochester.edu
OBJECTIVE: Review the evidence for various explanations for microbiologic
treatment failure following use of penicillin in group A streptococcal (GAS)
tonsillopharyngitis. DATA SOURCE: Systematic review of the literature based on
Medline and EMBASE searches, and review of reference lists of included studies.
RESULTS: The explanations for penicillin treatment failure in GAS
tonsillopharyngitis include 1) carrier state, 2) lack of compliance, 3)
recurrent exposure, 4) in vivo copathogenicity of beta-lactamase-producing
normal pharyngeal flora, 5) in vivo bacterial coaggregation, 6) poor antibiotic
penetration to tonsillopharyngeal tissue, 7) in vivo eradication of normal
protective flora, 8) early initiation of antibiotic therapy resulting in
suppression of an adequate host immune response, 9) intracellular localization
of GAS, 10) GAS tolerance to penicillin, 11) contaminated toothbrushes or
orthodontic appliances, and 12) transmission from the family pet. There is very
little
type I or II evidence to support any of the above-cited explanations for
treatment failure in GAS tonsillopharyngitis; available studies are mostly
observational (in patients) or laboratory-based without clinical confirmation.
CONCLUSION: Multiple explanations have been offered by investigators to explain
penicillin treatment failures in GAS tonsillopharyngitis, but the evidence base
to support the proposed explanations is generally weak by current standards.
Further research is needed to better understand the mechanism(s) of penicillin
treatment failure in GAS tonsillopharyngitis.
-----
Arch Otolaryngol Head Neck Surg. 2007 Oct;133(10):969-72.
Alterations of the oropharyngeal microbial flora after
adenotonsillectomy in children: a randomized controlled trial.
Le TM, Rovers MM, van Staaij BK, van den Akker EH, Hoes AW, Schilder AG.
Julius Center for Health Sciences and Primary Care, Department of
Otorhinolaryngology, E 04.140.5, Wilhelmina Children's Hospital, University
Medical Center Utrecht, PO Box 85090, 3590 AB Utrecht, the Netherlands.
OBJECTIVES: To determine whether the oropharyngeal microbial flora changes after
adenotonsillectomy (ATY) in children with mild to moderate symptoms of throat
infections or adenotonsillar hypertrophy and to relate these findings to
recurrence of throat infections. DESIGN: Randomized controlled trial. SETTING:
Twenty-three general hospitals and 3 academic centers. PATIENTS: Three hundred
children aged 2 to 8 years who were selected for ATY because of recurrent throat
infections (3-6 episodes per year) or obstructive complaints. Children with a
history of 7 or more throat infections in the previous year and those with a
high suspicion of obstructive sleep apnea according to current medical practice
were excluded. INTERVENTIONS: Children were randomly assigned to either ATY or
watchful waiting. Oropharyngeal swabs were taken at baseline and at 3 and 12
months after baseline. MAIN OUTCOME MEASURES: The primary outcome measure was
the prevalence of potentially pathogenic bacteria
in the oropharynx at 3 and 12 months. The secondary outcome measure was the
association between carriage of group A beta-hemolytic streptococci (GABHS) at
baseline and at 3 months' follow-up and the number of throat infections during
the 12 months of follow-up. RESULTS: In the ATY group, prevalences of
Haemophilus influenzae, GABHS, and Staphylococcus aureus decreased from 40%,
13%, and 5%, respectively, at baseline to respective levels of 24%, 0%, and 0%
at 3 months and 26%, 0%, and 0% at 12 months. In the watchful waiting group,
prevalences of H influenzae, GABHS, and S aureus did not change substantially.
In neither the ATY nor the watchful waiting group was carriage of GABHS
associated with recurrence of throat infections. CONCLUSIONS: Adenotonsillectomy
reduced oropharyngeal carriage of potential respiratory pathogens. Changes in
the carriage rate of GABHS, however, had no beneficial effect on recurrence of
throat infections.
-----
Rev Prat. 2007 Oct 31;57(16):1777-83.
[Pharyngitis in children]
[Article in French]
Cohen R.
Service de microbiologie, CHI Créteil, 94010 Créteil. robert.cohen@wanadoo.fr
The care strategy of pharyngitis has been changed dramatically these last years.
Because of evolution of antibiotic resistance, the attitude which prevailed of
the systematic treatment of pharyngitis in order to prevent a hypothetical acute
rheumatic fever, could not persist. Discrimination between pharyngitis due to
group A streptococcus (GAS) and nonstreptococcal pharyngitis (usually of viral
causes) cannot be made in a reliable way by the clinical signs and symptoms,
even if clinical scores are used. The free availability to practitioners of GAS
rapid diagnostic tests, sensitive (>90%) and specific (>95%), changes the rule
by simplifying it: pharyngitis with positive test must be treated with
antibiotics, those with negative test should not be received such treatment. A
reduction of two thirds of antibiotics consumption for pharyngitis can be
expected, while maintaining the benefit (improvement of the clinical signs,
reduction of contagiousness and the complications) for the patients for whom it
is necessary. Because of GAS resistance to macrolides and the absence of
resistance to beta-lactam antibiotics, a compound belonging of this last family
should be prescribed and for a short treatment duration: amoxicillin (50
mg/kg/j, b.i.d for 6 days), cefpodoxime proxetil (8 mg/kg/j b.i.d for 5 days),
cefuroxime axetil (30 mg/kg/j b.i.d for 4 days).
-----
Ann Fam Med. 2007 Sep-Oct;5(5):436-43.
Differences among international pharyngitis guidelines: not just
academic.
Matthys J, De Meyere M, van Driel ML, De Sutter A.
Department of Family Medicine and Primary Health Care, Ghent University,
Belgium. jan.matthys@ugent.be
PURPOSE: Many countries have national guidelines for the treatment of
pharyngitis. We wanted to compare the recommendations and the reported evidence
in national guidelines for the management of acute sore throat in adults.
METHODS: Guidelines were retrieved via MEDLINE and EMBASE and through a
Web-based search for guideline development organizations. The content of the
recommendations and the underlying evidence were analyzed with qualitative and
bibliometric methods. RESULTS: We included 4 North American and 6 European
guidelines. Recommendations differ with regard to the use of a rapid antigen
test and throat culture and with the indication for antibiotics. The North
American, French, and Finnish guidelines consider diagnosis of group A
streptococcus essential, and prevention of acute rheumatic fever remains an
important reason to prescribe antibiotics. In 4 of the 6 European guidelines,
acute sore throat is considered a self-limiting disease and antibiotics are not
recommended. The evidence used to underpin these guidelines was different in
North America and Europe. North American guidelines cited more North American
references than did European guidelines (87.2% vs 48.0%; ods ratio, 4.6-11.9;
P<.001). CONCLUSION: Although the evidence for the management of acute sore
throat is easily available, national guidelines are different with regard to the
choice of evidence and the interpretation for clinical practice. Also a
transparent and standardized guideline development method is lacking. These
findings are important in the context of appropriate antibiotic use, the problem
of growing antimicrobial resistance, and costs for the community.
-----
Otolaryngol Head Neck Surg. 2007 Aug;137(2):338-40.
Powered intracapsular tonsillectomy in the management of
recurrent tonsillitis.
Schmidt R, Herzog A, Cook S, O'reilly R, Deutsch E, Reilly J.
Division of Pediatric Otolaryngology, Alfred I. duPont Hospital for Children,
Wilmington, DE.
OBJECTIVE: To compare intracapsular tonsillectomy (IT) and traditional
tonsillectomy (TT) in treating recurrent adenotonsillitis or streptococcal
pharyngitis. DESIGN: Retrospective chart review. SETTING: Tertiary care
pediatric referral center. RESULTS: Of 166 patients who met all inclusion
criteria, 117 received TT and 49 received IT. Seventeen TT patients and 8 IT
patients were treated at least once postoperatively for streptococcal
pharyngitis or tonsillitis. The mean number of infections after surgery in each
group did not reach statistical significance (P = 0.295). CONCLUSION: There was
no difference between the IT and TT groups in postoperative infection rates.
-----
Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004877.
Chinese medicinal herbs for sore throat.
Shi Y, Gu R, Liu C, Ni J, Wu T.
BACKGROUND: Chinese herbal medicines are commonly used to treat sore throat in
China and among Chinese people worldwide. Their efficacy in treating sore throat
has not previously been systematically reviewed. OBJECTIVES: To assess the
efficacy and safety of Chinese herbal medicines for patients with sore throat.
SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials
(CENTRAL) (The Cochrane Library, Issue 3, 2006) which contains the Acute
Respiratory Infections Group's specialised register; MEDLINE (1966 to August
2006); EMBASE (1980 to August 2006); AMED (1985 to August 2006); the Chinese
Biomedical Database (CBM) (1975 to August 2006), and China National Knowledge
Infrastructure (CNKI) (1994 to August 2006). SELECTION CRITERIA: We only
included randomised controlled trials (RCTs) assessing Chinese herbal medicines
for the treatment of sore throat with the outcomes of recovery, inefficacy, and
adverse events. DATA COLLECTION AND ANALYSIS: One review author contacted the
trial authors of claimed RCTs. Three review authors extracted and analysed the
data. MAIN RESULTS: Seven trials involving 1253 participants were included. All
trials were identified as being of methodologically poor quality (C category).
All of the Chinese herbal preparations in this review were inadequately
characterised and were assessed in one trial only. It is highly likely that
there was selection bias or detection bias, or both, in all of the included
trials. Conflict of interest may have been another factor in producing a
positive result in three studies as the prepared drugs were made in the trial
author's hospital. We did not perform a meta-analysis and the results of the
studies are reported separately. Three formulations were shown to be superior to
the control in improving recovery: Ertong Qingyan Jiere Koufuye was more
effective than Fufang Shuanghua Koufuye for acute pharyngitis (OR 1.54, 95% Cl
1.11 to 5.74); Yanhouling mixture was more effective than the gentamicin
atomised inhalation for acute pharyngitis (OR 5.39, 95% CI 2.69 to 10.81) for
acute pharyngitis; and Qinganlan Liyan Hanpian was more effective than Fufang
Caoshanhu Hanpian for chronic pharyngitis (OR 2.25, 95% CI 1.08 to 4.67). Four
four formulations were shown to be equal in efficacy to the control. AUTHORS'
CONCLUSIONS: Based on the existing evidence included in this review, the
efficacy of Chinese herbal medicine for treating sore throat is controversial
and questionable. We cannot recommend any kind of Chinese medical herbal
formulation as an effective remedy for sore throat, due to the lack of high
quality clinical trials.
-----
BMJ. 2007 May 5;334(7600):939. Epub 2007 Mar 8. Comment in:
BMJ. 2007 May 19;334(7602):1019. BMJ. 2007 May 19;334(7602):1019. BMJ. 2007 May
5;334(7600):909.
Tonsillectomy versus watchful waiting in recurrent streptococcal
pharyngitis in adults: randomised controlled trial.
Alho OP, Koivunen P, Penna T, Teppo H, Koskela M, Luotonen J.
Department of Otolaryngology, University of Oulu, PO Box 5000, FIN-90014,
Finland. opalho@cc.oulu.fi
OBJECTIVE: To determine the short term efficacy and safety of tonsillectomy for
recurrent streptococcal pharyngitis in adults. Design Randomised controlled
trial. SETTING: Academic referral centre in Finland. PARTICIPANTS: 70 adults
with documented recurrent episodes of streptococcal group A pharyngitis.
INTERVENTION: Instant tonsillectomy (n=36) or remaining on waiting list as
control (n=34). MAIN OUTCOME MEASURES: Percentage change in the risk of an
episode of streptococcal pharyngitis at 90 days. Rates of all episodes of
pharyngitis and days with symptoms and adverse effects. RESULTS: The mean (SD)
follow-up was 164 (63) days in the control group and 170 (12) days in the
tonsillectomy group. At 90 days, streptococcal pharyngitis had recurred in 24%
(8/34) in the control group and 3% (1/36) in the tonsillectomy group (difference
21%; 95% confidence interval 6% to 36%). The number needed to undergo
tonsillectomy to prevent one recurrence was 5 (3 to 16). During the whole
follow-up, the rates of other episodes of pharyngitis and days with throat pain
and fever were significantly lower in the tonsillectomy group than in the
control group. The most common morbidity related to tonsillectomy was
postoperative throat pain (mean length 13 days, SD 4). CONCLUSIONS: Adults with
a history of documented recurrent episodes of streptococcal pharyngitis were
less likely to have further streptococcal or other throat infections or days
with throat pain if they had their tonsils removed. TRIAL REGISTRATION: Clinical
Trials NCT00136877.
-----
J Paediatr Child Health. 2007 Apr;43(4):203-13.
Group A streptococcal infections in children.
Steer AC, Danchin MH, Carapetis JR.
Centre for International Child Health, University of Melbourne, Department of
Paediatrics, Murdoch Childrens Research Institute, Royal Children's Hospital,
Melbourne, Victoria, Australia.
The group A streptococcus causes the widest range of disease in humans of all
bacterial pathogens. Group A streptococcal diseases are more common in children
than adults with diseases ranging from pharyngitis and impetigo to invasive
infections and the post-streptococcal sequelae--acute rheumatic fever and acute
post-streptococcal glomerulonephritis. The global burden of severe group A
streptococcal disease is concentrated largely in developing countries and
Indigenous populations such as Aboriginal Australians. Control of group A
streptococcal disease is poor in these settings and the need for a vaccine has
been argued. With an ever-increasing understanding of the group A streptococcus
at a molecular level, new and sophisticated vaccines are currently in human
trials and the next decade holds exciting prospects for curbing group A
streptococcal diseases.
-----
J Fam Pract. 2007 Mar;56(3):234-5.
Should you treat a symptomatic patient by phone when his child
has confirmed strep throat?
Sheridan E, Ludwig J, Helmen J, Thevatheril IT.
St Joseph Regional Medical Center, South Bend, IN USA.
Although no studies specifically evaluate this question, treatment for Group A
beta-hemolytic streptococcal (GABHS) pharyngitis without laboratory confirmation
in the general population is not advisable (strength of recommendation [SOR]: C,
based on consensus guidelines) due to poor diagnostic accuracy. When you suspect
GABHS pharyngitis either clinically or epidemiologically, confirm the diagnosis
of pharyngitis by a laboratory test. Patients with a positive throat culture or
a rapid antigen detection test should receive appropriate treatment with
antimicrobial therapy (SOR: A, based on clinical trials).
-----
BMJ. 2007 Mar 8; [Epub ahead of print]
Tonsillectomy versus watchful waiting in recurrent streptococcal
pharyngitis in adults: randomised controlled trial.
Alho OP, Koivunen P, Penna T, Teppo H, Koskela M, Luotonen J.
Department of Otolaryngology, University of Oulu, PO Box 5000, FIN-90014,
Finland.
OBJECTIVE: To determine the short term efficacy and safety of tonsillectomy for
recurrent streptococcal pharyngitis in adults.Design Randomised controlled
trial. SETTING: Academic referral centre in Finland. PARTICIPANTS: 70 adults
with documented recurrent episodes of streptococcal group A pharyngitis.
INTERVENTION: Instant tonsillectomy (n=36) or remaining on waiting list as
control (n=34). MAIN OUTCOME MEASURES: Percentage change in the risk of an
episode of streptococcal pharyngitis at 90 days. Rates of all episodes of
pharyngitis and days with symptoms and adverse effects. RESULTS: The mean (SD)
follow-up was 164 (63) days in the control group and 170 (12) days in the
tonsillectomy group. At 90 days, streptococcal pharyngitis had recurred in 24%
(8/34) in the control group and 3% (1/36) in the tonsillectomy group (difference
21%; 95% confidence interval 6% to 36%). The number needed to undergo
tonsillectomy to prevent one recurrence was 5 (3 to 16). During the whole
follow-up, the rates of other episodes of pharyngitis and days with throat pain
and fever were significantly lower in the tonsillectomy group than in the
control group. The most common morbidity related to tonsillectomy was
postoperative throat pain (mean length 13 days, SD 4). CONCLUSIONS: Adults with
a history of documented recurrent episodes of streptococcal pharyngitis were
less likely to have further streptococcal or other throat infections or days
with throat pain if they had their tonsils removed.Trial registration Clinical
Trials NCT00136877.
-----
Diagn Microbiol Infect Dis. 2007 Mar;57(3 Suppl):S39-45. Epub 2007 Feb 9.
The evidence base for cephalosporin superiority over penicillin
in streptococcal pharyngitis.
Casey JR, Pichichero ME.
Elmwood Pediatric Group, University of Rochester, Rochester, NY 14642, USA.
Current treatment guidelines from the Infectious Diseases Society of America,
the American Heart Association, and the American Academy of Pediatrics recommend
only oral penicillin V or intramuscular benzathine penicillin G as the drugs of
choice for treatment of group A beta-hemolytic streptococcal (GABHS) pharyngitis.
Ten-day treatment courses with 1st-generation oral cephalosporins or
erythromycin are recommended as suitable alternatives in patients who are
allergic to penicillin. Despite these recommendations, oral cephalosporins are
used as drugs of choice for many patients with GABHS pharyngitis. Simpler and/or
short-course regimens of cephalosporins that have been approved by the Food and
Drug Administration offer alternatives with the potential for unchanged patient
compliance. Increasing cephalosporin use in patients with GABHS pharyngitis has
followed from numerous reports and metaanalyses of cephalosporin superiority
over penicillin for bacteriologic eradication and clinical response. This review
examines the evidence supporting the use of cephalosporins as a first choice of
treatment for many patients with GABHS pharyngitis.
-----
J Gen Intern Med. 2007 Jan;22(1):127-30.
Pharyngitis management: defining the controversy.
Centor RM, Allison JJ, Cohen SJ.
University of Alabama at Birmingham, Birmingham, AL 35294-3407, USA. rcentor@uab.edu
Full text at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17351852
Despite numerous controlled trials, clinical practice guidelines and
cost-effective analyses, controversy persists regarding the appropriate
management strategy for adult pharyngitis. In this perspective, we explore this
controversy by comparing two competing clinical guidelines. Although the
guidelines appear to make widely diverging recommendations, we show that the
controversy centers on only a small proportion of patients: those presenting
with severe pharyngitis. We examine recently published data to illustrate that
this seemingly simple problem of strep throat remains a philosophical issue:
should we give primacy to relieving acute time-limited symptoms, or should we
emphasize the potential societal risk of antibiotic resistance? We accept
potentially over treating a minority of adult pharyngitis patients with the most
severe presentations to reduce suffering in an approximately equal number of
patients who will have false negative test results if the test-and-treat
strategy were used.
-----
Pediatr Infect Dis J. 2007 Feb;26(2):139-141.
Efficacy of Antibiotic Prophylaxis for Intrafamilial Transmission
of Group A beta-Hemolytic Streptococci.
Kikuta H, Shibata M, Nakata S, Yamanaka T, Sakata H, Fujita K, Kobayashi K.
From the Pediatric Clinic, Touei Hospital, Sapporo, Japan; the Department of
Pediatrics, Health Sciences University of Hokkaido; Nakata Pediatric Clinic;
Yamanaka Tatsuru Pediatrics; Department of Pediatrics, Asahikawa Kosei Hospital;
Sapporo City Institute of Public Health, Sapporo, Japan; and the Department of
Pediatrics, Sapporo Hokuyu Hospital, Sapporo, Japan.
BACKGROUND:: The role of chemoprophylaxis for household contacts of patients
with acute streptococcal disease is uncertain. METHODS:: The subjects were 1440
sibling contacts of 1181 index patients with group A beta-hemolytic
streptococcal (GABHS) pharyngitis. Instances of subsequent GABHS pharyngitis in
sibling contacts who received chemoprophylaxis and in a control group without
prophylaxis were compared. RESULTS:: Of the 948 siblings in the prophylaxis
group, 507 were treated with cephalosporins and 441 were treated with
penicillins for 3 to 5 days. Subsequent GABHS pharyngitis occurred within 30
days in 28 (3.0%) of the 948 siblings in the prophylaxis group and in 26 (5.3%)
of the 492 siblings in the control group. Among siblings in the prophylaxis
group, subsequent GABHS pharyngitis occurred in 9 (1.8%) of the 507 siblings in
the cephalosporin prophylaxis group and in 19 (4.3%) of the 441 siblings in the
penicillin prophylaxis group. When these data were each compared with that in
the control group (5.3%), a significant statistical difference was seen in the
cephalosporin prophylaxis group (P = 0.003) but not in the penicillin
prophylaxis group (P = 0.542). Only 5-day cephalosporin prophylaxis showed
significant reduction in the rate of subsequent GABHS pharyngitis compared with
that in the control group (P = 0.002). CONCLUSIONS:: In view of the low
incidence of subsequent GABHS pharyngitis in the nonprophylaxis group, the usual
self-limited nature of GABHS pharyngitis, the cost of prophylaxis and the risk
for selecting resistant flora, routine chemoprophylaxis against GABHS
pharyngitis for sibling contacts is not recommended.
-----
Laryngoscope. 2006 Nov;116(11):1946-50.
Efficacy of tonsillectomy in treatment of recurrent group A
beta-hemolytic streptococcal pharyngitis.
Orvidas LJ, St Sauver JL, Weaver AL.
Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota 55905, USA.
orvidas.laura@mayo.edu
OBJECTIVE: The objective of this study was to determine whether children with
tonsillectomies experienced fewer recurrent group A beta-hemolytic streptococcal
(GABHS) infections after surgery compared with children who did not receive
tonsillectomies. STUDY DESIGN/METHODS: The authors conducted a retrospective
cohort study of 290 children 4 to <16 years who experienced three or more
episodes of group A beta-hemolytic streptococcal pharyngitis at least 1 month
apart in 12 months. RESULTS: Children without tonsillectomy were 3.1 times (95%
confidence interval, 1.9-4.9; P < .001) more likely to develop a subsequent
group A beta-hemolytic streptococcal pharyngitis infection during follow up than
children who underwent tonsillectomy after adjusting for the number of group A
beta-hemolytic streptococcal pharyngitis infections per patient within the
previous year and the presence of preexisting conditions. Among the children who
developed a subsequent group A beta-hemolytic streptococcal pharyngitis
infection, the children without a tonsillectomy developed a group A
beta-hemolytic streptococcal pharyngeal infection sooner (median, 0.6 vs. 1.1
years). CONCLUSIONS: Tonsillectomy is associated with a decrease in the number
of group A beta-hemolytic streptococcal pharyngitis infections in children with
a history of recurrent groups A beta-hemolytic streptococcal pharyngitis
infection. Tonsillectomy also increased the amount of time before development of
further GABHS pharyngitis.
Previous Strep Throat
Research: 2002-2006
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File also contains summaries of past
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