[Utility of clinical differentiation and microbiological examination for appropriate antibiotic therapy of acute pharyngotonsillitis in children].

UNLABELLED

The differentiation between streptococcal pharyngotonsillitis and that of viral etiology is crucial, since it allows to discriminate patients who need to be treated with the use of antibiotics from those who only need symptomatic treatment. For that purpose, Centor/Mclssac's scale, based on the clinical examination and a history of a patient, is suggested by "Polish Recommendations for the diagnosis and treatment of community-acquired respiratory tract infections 2010". In patients who have obtained two or more points according to this scale, a definitive diagnosis of streptococcal pharyngotonsillitis depends on the identification of the bacterium, which can be performed by throat swab culture or by rapid antigen detection test. The aim of the study was to evaluate utility of clinical differentiation, rapid antigen detection test and throat swab culture for appropriate antibiotic therapy of acute pharyngotonsillitis in children. To the best of our knowledge, this is the first survey of this type carried out in Poland.

MATERIAL AND METHODS

42 children in the age of 3-14 years with acute pharyngotonsillitis who obtained at least two points in Centor/ Mclssac's scale took part in our study. Two throat swabs were obtained from every child, one of them was used to perform rapid test, and the second one was cultured on Columbia blood agar. Grey-white colonies with beta-hemolysis were classified to the groups A, B, C, D, F and G according to Lancefield with the use of bacitracin discs and latex agglutination test.

RESULTS

50% of children obtained 4 points and 40.5% of them received 5 points in Centor/Mclssac's scale. QuickView+ Strep A test turned up to be consistent with culture in 97.6% of cases. On the grounds of rapid test and culture results patients were subdivided into 3 groups: I--infected with S. pyogenes (50.0%), II--infected with other groups of beta-hemolytic streptococci (9.5%), III--infected with viruses (40.5%).

CONCLUSIONS

It is impossible to recognize streptococcal pharyngitis only on clinical grounds, the diagnosis must be confirmed by laboratory methods. In children with high risk of streptococcal pharyngitis QuickView+Strep A test possesses diagnostic value comparable to culture in the detection of S. pyogenes, however negative rapid test results in such patients should be confirmed by culture. Antibiotic therapy should be initiated on the base of microbiological examination.