de Jongh Egbert, Opstelten Wim
Nederlands Huisartsen Genootschap, afdeling Richtlijnontwikkeling en Wetenschap, Utrecht.
Ned Tijdschr Geneeskd. 2015;159:A9456.
The aim of a diagnostic work-up in patients with acute sore throat is to exclude serious causes of tonsillitis and, in cases of a pharyngotonsillitis, to assess the degree of illness and the risk of complications. A diagnostic work-up aimed at the distinction between a viral or bacterial cause of pharyngotonsillitis does not determine initial treatment policy. Pharyngotonsillitis usually has a benign natural course; patient information and analgesia are usually sufficient treatment. Complications of an infection with group A streptococci are rare; diagnostic work-up for this bacterial cause is, therefore, not recommended. Antibiotics are only useful in cases of severe pharyngotonsillitis, increased risk of complications or a peritonsillar infiltration. The antibiotic of choice is a narrow spectrum penicillin; however, amoxicillin/clavulanate is indicated in patients with peritonsillar infiltration. If there is discrepancy in adults between the severity of symptoms and findings on physical examination, the possibility of epiglottitis should be considered.
对急性咽痛患者进行诊断性检查的目的是排除扁桃体炎的严重病因，对于咽扁桃体炎患者，要评估疾病的严重程度和并发症风险。旨在区分咽扁桃体炎病毒或细菌病因的诊断性检查并不能决定初始治疗策略。咽扁桃体炎通常具有良性自然病程；患者信息和止痛通常就足够治疗。A组链球菌感染的并发症很少见；因此，不建议针对这种细菌病因进行诊断性检查。抗生素仅在严重咽扁桃体炎、并发症风险增加或扁桃体周围浸润的情况下有用。首选抗生素是窄谱青霉素；然而，对于有扁桃体周围浸润的患者，应使用阿莫西林/克拉维酸。如果成人症状严重程度与体格检查结果存在差异，应考虑会厌炎的可能性。
