Cooper R J, Hoffman J R, Bartlett J G, Besser R E, Gonzales R, Hickner J M, Sande M A
University of California, Los Angeles, Emergency Medicine Center, 924 Westwood Boulevard, Suite 300, Los Angeles, CA 90024, USA.
Ann Intern Med. 2001 Mar 20;134(6):509-17. doi: 10.7326/0003-4819-134-6-200103200-00019.
The following principles of appropriate antibiotic use for adults with acute pharyngitis apply to immunocompetent adults without complicated comorbid conditions, such as chronic lung or heart disease, and history of rheumatic fever. They do not apply during known outbreaks of group A streptococcus.1. Group A beta-hemolytic streptococcus (GABHS) is the causal agent in approximately 10% of adult cases of pharyngitis. The large majority of adults with acute pharyngitis have a self-limited illness, for which supportive care only is needed.2. Antibiotic treatment of adult pharyngitis benefits only those patients with GABHS infection. All patients with pharyngitis should be offered appropriate doses of analgesics and antipyretics, as well as other supportive care.3. Limit antibiotic prescriptions to patients who are most likely to have GABHS infection. Clinically screen all adult patients with pharyngitis for the presence of the four Centor criteria: history of fever, tonsillar exudates, no cough, and tender anterior cervical lymphadenopathy (lymphadenitis). Do not test or treat patients with none or only one of these criteria, since these patients are unlikely to have GABHS infection. For patients with two or more criteria the following strategies are appropriate: a) Test patients with two, three, or four criteria by using a rapid antigen test, and limit antibiotic therapy to patients with positive test results; b) test patients with two or three criteria by using a rapid antigen test, and limit antibiotic therapy to patients with positive test results or patients with four criteria; or c) do not use any diagnostic tests, and limit antibiotic therapy to patients with three or four criteria. 4. Throat cultures are not recommended for the routine primary evaluation of adults with pharyngitis or for confirmation of negative results on rapid antigen tests when the test sensitivity exceeds 80%. Throat cultures may be indicated as part of investigations of outbreaks of GABHS disease, for monitoring the development and spread of antibiotic resistance, or when such pathogens as gonococcus are being considered.5. The preferred antibiotic for treatment of acute GABHS pharyngitis is penicillin, or erythromycin in a penicillin-allergic patient.
以下适用于免疫功能正常、无慢性肺部或心脏病等复杂合并症及风湿热病史的成年急性咽炎患者的抗生素合理使用原则，不适用于已知的A组链球菌暴发期间。
A组β溶血性链球菌（GABHS）是约10%成年咽炎病例的病原体。绝大多数成年急性咽炎患者病情自限，仅需支持治疗。
成年咽炎患者的抗生素治疗仅对GABHS感染患者有益。所有咽炎患者均应给予适当剂量的镇痛药和解热药以及其他支持治疗。
将抗生素处方限于最可能感染GABHS的患者。对所有成年咽炎患者进行临床筛查，看是否存在四项森托标准：发热史、扁桃体渗出物、无咳嗽以及颈前淋巴结触痛（淋巴结炎）。对于无这些标准或仅有一项标准的患者，无需检测或治疗，因为这些患者不太可能感染GABHS。对于有两项或更多标准的患者，以下策略是合适的：a）对有两项、三项或四项标准的患者进行快速抗原检测，仅对检测结果呈阳性的患者进行抗生素治疗；b）对有两项或三项标准的患者进行快速抗原检测，仅对检测结果呈阳性的患者或有四项标准的患者进行抗生素治疗；或c）不使用任何诊断检测，仅对有三项或四项标准的患者进行抗生素治疗。
当快速抗原检测敏感度超过80%时，不建议对成年咽炎患者进行常规初步评估时或用于确认快速抗原检测阴性结果时进行咽拭子培养。咽拭子培养可作为GABHS疾病暴发调查的一部分、监测抗生素耐药性的发展和传播或在考虑如淋球菌等病原体时进行。
治疗急性GABHS咽炎的首选抗生素是青霉素，对青霉素过敏的患者可用红霉素。
