Department of Sciences for Woman and Child's Health, University of Florence, Florence, Italy.
Clin Ther. 2011 Jan;33(1):48-58. doi: 10.1016/j.clinthera.2011.02.001.
Streptococcal pharyngitis is a frequently observed condition, but its optimal management continues to be debated.
The goal of this study was to evaluate the available guidelines, developed at the national level, for the management of streptococcal pharyngitis in Western countries, with a focus on their differences.
A literature search was conducted of the Cochrane Library, EMBASE, TRIP, and MEDLINE databases from their inception (1993 for the Cochrane Library, 1980 for EMBASE, 1997 for TRIP, and 1966 for MEDLINE) through April 25, 2010. The following search terms were used: pharyngitis, sore throat, tonsillitis, pharyngotonsillitis, Streptococcus pyogenes, Group A β-haemolytic Streptococcus pyogenes, and streptococcal pharyngitis. Searches were limited to type of article or document (practice guideline or guideline) with no language restrictions or language limits.
Twelve national guidelines were identified: 6 from European countries (France, United Kingdom, Finland, Holland, Scotland, and Belgium), 5 from the United States, and 1 from Canada. Recommendations differ substantially with regard to the use of a rapid antigen diagnostic test or throat culture and the indications for antibiotic treatment. The North American, Finnish, and French guidelines recommend performing one timely microbiologic investigation in suspected cases, and prescribing antibiotics in confirmed cases to prevent suppurative complications and acute rheumatic fever. According to the remaining European guidelines, however, acute sore throat is considered a benign, self-limiting disease. Microbiologic tests are not routinely recommended by these latter guidelines, and antibiotic treatment is reserved for well-selected cases. The use of the Centor score, for evaluation of the risk of streptococcal infection, is recommended by several guidelines, but subsequent decisions on the basis of the results differ in terms of which subjects should undergo microbiologic investigation. All guidelines agree that narrow-spectrum penicillin is the first choice of antibiotic for the treatment of streptococcal pharyngitis and that treatment should last for 10 days to eradicate the microorganism. Once-daily amoxicillin was recommended by 2 US guidelines as equally effective.
The present review found substantial discrepancies in the recommendations for the management of pharyngitis among national guidelines in Europe and North America.
链球菌性咽炎是一种常见病症，但最佳治疗方案仍存在争议。
本研究旨在评估在西方国家制定的、国家级别的链球菌性咽炎管理指南，并重点关注其差异。
从 Cochrane 图书馆、EMBASE、TRIP 和 MEDLINE 数据库中检索文献，检索时间从数据库建立（Cochrane 图书馆为 1993 年，EMBASE 为 1980 年，TRIP 为 1997 年，MEDLINE 为 1966 年）至 2010 年 4 月 25 日。使用以下检索词：咽炎、咽痛、扁桃体炎、咽扁桃体炎、化脓性链球菌、A 组β-溶血性链球菌、链球菌性咽炎。检索仅限于文章或文件类型（实践指南或指南），无语言限制或语言限制。
确定了 12 个国家级指南：6 个来自欧洲国家（法国、英国、芬兰、荷兰、苏格兰和比利时），5 个来自美国，1 个来自加拿大。在使用快速抗原诊断试验或咽拭子培养以及抗生素治疗的适应证方面，建议存在很大差异。北美、芬兰和法国的指南建议在疑似病例中进行一次及时的微生物学调查，并在确诊病例中开具抗生素，以预防化脓性并发症和急性风湿热。然而，根据其余的欧洲指南，急性咽痛被认为是一种良性、自限性疾病。这些指南不常规推荐微生物学检查，抗生素治疗仅保留给精选病例。几项指南建议使用 Centor 评分评估链球菌感染的风险，但根据评分结果做出的后续决策在哪些患者应进行微生物学检查方面存在差异。所有指南均同意窄谱青霉素是治疗链球菌性咽炎的首选抗生素，治疗应持续 10 天以根除微生物。有 2 个美国指南建议每日 1 次阿莫西林同样有效。
本综述发现，欧洲和北美的国家级指南在咽炎管理建议方面存在很大差异。
