Gerber M A, Randolph M F, DeMeo K K, Kaplan E L
Department of Pediatrics, University of Connecticut School of Medicine, Farmington 06032.
J Pediatr. 1990 Dec;117(6):853-8. doi: 10.1016/s0022-3476(05)80121-0.
To determine whether recurrence rates for group A beta-hemolytic streptococcal (GABHS) pharyngitis are related to the time of initiation of antibiotic therapy, we randomly assigned 113 patients with GABHS pharyngitis either to a group that began a 10-day course of penicillin V at the time of diagnosis or to a group that began the same antibiotic regimen after a dealy of 48 hours. Follow-up throat culture specimens were obtained 4 days, 2 months, and 4 months after the completion of antibiotic therapy, as well as during any interim episodes of acute pharyngitis. Serotyping of all GABHS isolates was performed to distinguish between recurrences with homologous serotypes and new acquisitions with heterologous serotypes. There was no significant difference between the two treatment groups in age, gender, duration of illness before enrollment in the study, initial clinical presentation, or compliance. Of the 50 patients in the immediate-treatment group, 6 (12%) had homologous serotypes of GABHS isolated on one of the follow-up throat cultures. Of the 63 patients in the delayed-treatment group, 9 (14%) had homologous serotypes of GABHS isolated on one of the follow-up throat cultures. These data indicate that a 48-hour delay in the initiation of penicillin therapy for GABHS pharyngitis does not reduce the recurrence rate.
为了确定A组β溶血性链球菌（GABHS）咽炎的复发率是否与抗生素治疗开始时间有关，我们将113例GABHS咽炎患者随机分为两组，一组在诊断时开始为期10天的青霉素V治疗疗程，另一组在延迟48小时后开始相同的抗生素治疗方案。在完成抗生素治疗后4天、2个月和4个月，以及在急性咽炎的任何中间发作期间，获取随访咽喉培养标本。对所有GABHS分离株进行血清分型，以区分同源血清型的复发和异源血清型的新感染。两个治疗组在年龄、性别、入组研究前的病程、初始临床表现或依从性方面没有显著差异。在即时治疗组的50例患者中，有6例（12%）在一次随访咽喉培养中分离出同源血清型的GABHS。在延迟治疗组的63例患者中，有9例（14%）在一次随访咽喉培养中分离出同源血清型的GABHS。这些数据表明，GABHS咽炎青霉素治疗开始延迟48小时不会降低复发率。
