School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, Aldermoor Health Centre, Aldermoor Close, Southampton SO16 5ST, UK.
Trans R Soc Trop Med Hyg. 2022 Apr 4;116(4):286-297. doi: 10.1093/trstmh/trab156.
Concerns about rheumatic fever (RF) drive antibiotic prescriptions for sore throat (ST) in endemic areas. Better guidance is needed on which patients are likely to develop RF in order to avoid misuse and overuse of antibiotics. Our aim was to identify predictive factors for RF in ST patients.
Multiple databases were searched to identify cohort, case-control, cross-sectional or randomised controlled trials that measured RF incidence in ST patients. An inverse variance random effects model was used to pool the data and calculate odds ratios (ORs).
Seven studies with a total of 6890 participants were included: three RCTs and four observational studies. Factors significantly associated with RF development following ST were positive group A streptococcal (GAS) swab (OR 1.74 [95% confidence interval {CI} 1.13 to 2.69]), previous RF history (OR 13.22 [95% CI 4.86 to 35.93]) and a cardiac murmur (OR 3.55 [95% CI 1.81 to 6.94]). Many potential risk factors were not reported in any of the included studies, highlighting important evidence gaps.
ST patients in endemic areas with a positive GAS swab, previous RF history and a cardiac murmur are at increased risk of developing RF. This review identifies vital gaps in our knowledge of factors predicting RF development in ST patients. Further research is needed to develop better clinical prediction tools and rationalise antibiotic use for ST.
风湿热（RF）的担忧促使在流行地区对咽痛（ST）患者开具抗生素处方。为了避免抗生素的滥用和过度使用，需要更好的指导来确定哪些患者可能会发展为 RF。我们的目的是确定 ST 患者 RF 的预测因素。
检索多个数据库以确定队列、病例对照、横断面或随机对照试验，这些试验测量了 ST 患者的 RF 发生率。使用逆方差随机效应模型对数据进行汇总，并计算比值比（OR）。
共有 7 项研究，总计 6890 名参与者，包括 3 项 RCT 和 4 项观察性研究。与 ST 后 RF 发展相关的因素有：GAS 拭子阳性（OR 1.74 [95%CI 1.13 至 2.69]）、既往 RF 病史（OR 13.22 [95%CI 4.86 至 35.93]）和心脏杂音（OR 3.55 [95%CI 1.81 至 6.94]）。许多潜在的危险因素在任何纳入的研究中均未报告，这突出了重要的证据差距。
在流行地区，ST 患者中 GAS 拭子阳性、既往 RF 病史和心脏杂音的患者发生 RF 的风险增加。该综述确定了我们在 ST 患者 RF 发展预测因素方面的知识存在重要差距。需要进一步研究以开发更好的临床预测工具并合理使用抗生素治疗 ST。
