Flottorp S, Oxman A D, Cooper J G, Hjortdahl P, Sandberg S, Vorland L H
Seksjon for helsetjenesteforskning Statens institutt for folkehelse, Oslo.
Tidsskr Nor Laegeforen. 2000 Jun 10;120(15):1754-60.
Available guidelines for the diagnosis and treatment of sore throat give conflicting recommendations. Our aim was to develop evidence-based guidelines.
We searched The Cochrane Library, Medline and other sources for systematic reviews and other evidence that met explicit inclusion criteria for all of the relevant options and outcomes we identified. The validity of included studies was assessed. Draft recommendations based on assessment of this evidence were widely circulated and discussed in focus groups with patients and physician assistants.
Throat infections are self-limiting and complications rare. Penicillin shortens the duration of symptoms in tonsillitis caused by beta-haemolytic streptococci and reduces the risk of complications. Penicillin has adverse effects and increases the risk of reinfections. Patients with sore throat should usually be treated without antibiotics. Visiting a physician is normally unnecessary. Antibiotics should be considered in serious cases or if the patient prefers this, but should only be prescribed for throat infections caused by beta-haemolytic streptococci. The diagnosis should be based on clinical criteria and a rapid antigen test in cases of doubt.
Benefits of antibiotics must be weighed against harms. Patients should be given good information and involved in decision-making if they want antibiotics.
现有的咽痛诊断和治疗指南给出了相互矛盾的建议。我们的目标是制定基于证据的指南。
我们检索了考克兰图书馆、医学期刊数据库及其他来源，以获取针对我们确定的所有相关选项和结果符合明确纳入标准的系统评价及其他证据。对纳入研究的有效性进行了评估。基于对这些证据的评估得出的建议草案在与患者和医师助理的焦点小组中广泛分发并进行了讨论。
咽喉感染具有自限性，并发症罕见。青霉素可缩短由β溶血性链球菌引起的扁桃体炎的症状持续时间，并降低并发症风险。青霉素有不良反应，且会增加再次感染的风险。咽痛患者通常无需使用抗生素治疗。通常无需就医。在严重病例或患者希望使用抗生素时可考虑使用，但仅应为由β溶血性链球菌引起的咽喉感染开具抗生素。诊断应基于临床标准，存疑时进行快速抗原检测。
必须权衡抗生素的益处与危害。如果患者想要使用抗生素，应向其提供充分信息并让其参与决策。
