Bégué P
Service de Consultation de Pédiatrie et de Pathologie Infectieuse et Tropicale, Hôpital Trousseau, Paris.
Ann Pediatr (Paris). 1991 Oct;38(8):545-8.
Antimicrobial therapy of pharyngitis focuses mainly on eradicating group A streptococci and treating recurrent pharyngitis. The French strategy rests on routine treatment of all cases of childhood pharyngitis; in the United-States, rapid tests are used to identify group A streptococci in the throat before treating. Antibiotics used against group A streptococci include beta-lactams and macrolides. Among beta-lactams, the reference drug is still penicillin, e.g., penicillin V for 10 days. However, numbers of carriers with positive throat cultures for Streptococcus pyogenes seem to be growing in the United States, with a 10-20% increase over the last twenty years. Duration of therapy could be reduced from 10 to 5 days with the new oral cephalosporins but these drugs are more expensive than penicillin. Recurrent pharyngitis is caused by a variety of organisms which are often penicillinase-producers. It follows that penicillin should not be used in these cases, which require oral cephalosporins or the amoxicillin-clavulanic acid combination. Maintenance antimicrobial therapy between acute episodes should be considered.
咽炎的抗菌治疗主要集中在根除A组链球菌以及治疗复发性咽炎。法国的策略是对所有儿童咽炎病例进行常规治疗；在美国，则在治疗前使用快速检测来识别咽喉中的A组链球菌。用于对抗A组链球菌的抗生素包括β-内酰胺类和大环内酯类。在β-内酰胺类中，参考药物仍然是青霉素，例如10天的青霉素V。然而，在美国，化脓性链球菌咽喉培养阳性的携带者数量似乎在增加，在过去二十年中增加了10%至20%。使用新型口服头孢菌素治疗疗程可从10天减至5天，但这些药物比青霉素更昂贵。复发性咽炎由多种微生物引起，这些微生物通常是青霉素酶产生菌。因此，在这些情况下不应使用青霉素，而需要使用口服头孢菌素或阿莫西林-克拉维酸组合。应考虑在急性发作之间进行维持抗菌治疗。
