Dillon H C
Pediatr Infect Dis J. 1987 Jan;6(1):123-30. doi: 10.1097/00006454-198701000-00053.
Streptococcal pharyngitis remains a common problem in children and adolescents. However, the incidence of acute rheumatic fever is now quite low except in developing countries. Proper management of streptococcal pharyngitis has contributed significantly to the decline in ARF. Penicillin treatment has clearly altered the natural history of streptococcal infection; the acute illness is shortened, risk of spread of infection is reduced, suppurative complications are prevented and ARF is prevented. Some cases of acute glomerulonephritis may be prevented. The decline in rheumatic fever has probably contributed to a greater interest in clinical benefits of therapy. Antigen detection tests appear promising for providing a more rapid bacteriologic diagnosis of streptococcal infection, which in turn permits prompt treatment. While penicillin has been the treatment of choice for four decades, a disturbing trend of increasing numbers of clinical relapses or recurrent infections has been noted in recent years. Alternative antibiotics, such as the oral cephalosporins, may now be superior to oral penicillin in terms of lessening the risk of relapse. This advantage must be weighed against other factors including cost effectiveness. The most pressing dilemma for the clinician is management of the patient with repeated episodes of acute streptococcal pharyngitis. Certain of these problem patients may benefit from a period of penicillin prophylaxis during the seasons when streptococcal infections are most prevalent. There is now agreement that posttreatment throat cultures need not be done in the child who remains asymptomatic following therapy. However, it is incumbent on the clinician to make certain that appropriate therapy is prescribed and that compliance with oral regimens of therapy is satisfactory in the management of the patient with acute streptococcal pharyngitis.
链球菌性咽炎在儿童和青少年中仍然是一个常见问题。然而，除了在发展中国家，急性风湿热的发病率现在相当低。对链球菌性咽炎的妥善管理对急性风湿热发病率的下降起到了显著作用。青霉素治疗明显改变了链球菌感染的自然病程；急性疾病缩短，感染传播风险降低，化脓性并发症得到预防，急性风湿热也得到预防。一些急性肾小球肾炎病例也可能得到预防。风湿热发病率的下降可能促使人们对治疗的临床益处产生了更大的兴趣。抗原检测试验在提供更快速的链球菌感染细菌学诊断方面似乎很有前景，这反过来又能实现及时治疗。虽然青霉素在过去四十年一直是首选治疗药物，但近年来注意到临床复发或反复感染的病例数量呈令人不安的上升趋势。替代抗生素，如口服头孢菌素，在降低复发风险方面可能现在优于口服青霉素。这种优势必须与包括成本效益在内的其他因素相权衡。临床医生最紧迫的困境是如何管理反复发生急性链球菌性咽炎的患者。这些问题患者中的一部分在链球菌感染最普遍的季节接受一段时间的青霉素预防治疗可能会受益。现在人们一致认为，治疗后无症状的儿童无需进行咽喉培养。然而，临床医生有责任确保开出适当的治疗方案，并确保急性链球菌性咽炎患者在口服治疗方案中的依从性令人满意。
