Sarrell E Michael, Giveon Shmuel M
Pediatric and Adolescent Ambulatory Community Clinics-Clalit Health Care Services, 128 Alozorov Street, Tel-Aviv, Israel.
ISRN Pediatr. 2012;2012:796389. doi: 10.5402/2012/796389. Epub 2012 Jun 21.
Background. Uncertainty exists concerning the necessity of 10-day antibiotic treatment of group A beta hemolytic streptococcus (GABHS) pharyngitis. Objective. To assess the incidence of GABHS recurrence and suppurative and nonsuppurative complications in relation to compliance. Methods. (Design). Prospective cohort observational study. (Subjects). 2,000 children aged 6 months to 18 years with sore throat and positive GABHS culture. (Main Outcome Measures). Recurrence of symptomatic culture positive GABHS pharyngitis, incidence of suppurative, and long-term, regional, nonsuppurative complications of GABHS pharyngitis, over a ten year period. Results. 213 (11%) of the children received no treatment. Most children received antibiotics for only 4-6 days (in correlation with the duration of fever, which in most cases lasted up to 3 days). Three hundred and six (15.3%) children had clinically diagnosed recurrent tonsillopharyngitis; 236 (12.3%) had positive GABHS findings within 10 to 14 days and thirty-four (1.7%) within 21-30 days after the index positive GABHS culture. The remaining 1.3% had no positive culture despite the clinical findings. Almost all recurrences [236 (11.6%)] occurred within 14 days and 156 (7.6%) in the fully treated group. The presence of fever during the first 3 days of the disease was the most significant predictor for recurrence. Other predictors were the age younger than 6 years and the presence of cervical lymphadenitis. No increase in the incidence of nonsuppurative or suppurative complications was noted during the 10-year follow-up period, compared to the past incidence of those complications in Israel. Conclusions. Our data suggests that the majority of children discontinue antibiotics for GABHS tonsillopharyngitis a day or two after the fever subsides. The incidence of complications in our study was not affected by this poor compliance.
背景。关于A组β溶血性链球菌（GABHS）咽炎进行10天抗生素治疗的必要性存在不确定性。目的。评估GABHS复发以及化脓性和非化脓性并发症的发生率与依从性的关系。方法。（设计）前瞻性队列观察研究。（研究对象）2000名年龄在6个月至18岁之间、咽痛且GABHS培养呈阳性的儿童。（主要观察指标）在十年期间，有症状的培养阳性GABHS咽炎的复发情况、GABHS咽炎的化脓性及长期、局部非化脓性并发症的发生率。结果。213名（11%）儿童未接受治疗。大多数儿童仅接受了4 - 6天的抗生素治疗（与发热持续时间相关，大多数情况下发热持续长达3天）。306名（15.3%）儿童临床诊断为复发性扁桃体咽炎；236名（12.3%）在首次GABHS培养阳性后的10至14天内GABHS检测结果呈阳性，34名（1.7%）在21 - 30天内呈阳性。其余1.3%尽管有临床症状但培养结果为阴性。几乎所有复发情况[236例（11.6%）]发生在14天内，完全接受治疗组中有156例（7.6%）。疾病前3天出现发热是复发的最显著预测因素。其他预测因素包括年龄小于6岁以及存在颈部淋巴结炎。与以色列过去这些并发症的发生率相比，在10年随访期间未发现非化脓性或化脓性并发症的发生率增加。结论。我们的数据表明，大多数儿童在发热消退后一到两天就停止了针对GABHS扁桃体咽炎的抗生素治疗。本研究中并发症的发生率并未受到这种依从性差的影响。
