McCracken G H
Pediatr Infect Dis. 1986 Nov-Dec;5(6):754-9. doi: 10.1097/00006454-198611000-00062.
Physicians must be aware that rheumatic fever can no longer be considered a disease of the past and be prepared to diagnose and treat promptly children with streptococcal pharyngitis. Although the rapid diagnostic kits for detecting Group A streptococci in pharyngeal swabs are not perfect, they can be useful to the practitioner if positive because the specificity of the test is excellent. Thus, a child with pharyngitis who has a positive rapid test should be treated immediately to shorten the period of morbidity and to reduce the risk of nonsuppurative sequelae. Upon completion of a 10-day treatment course there is usually no reason to reculture the pharynx if the child is asymptomatic. Recurrence of symptoms is an indication to perform another culture and to retreat with either benzathine penicillin G or erythromycin depending on compliance of the patient and the agent used initially for therapy. Eradication of Group A streptococci from the pharynx of children who are carriers is usually a difficult and unnecessary task. When eradication is indicated, such as when the carrier has had contact with a person who had rheumatic fever, rifampin should be added to the penicillin regimen (Table 4).
医生必须意识到，风湿热不再能被视为一种过去的疾病，并且要准备好及时诊断和治疗患有链球菌性咽炎的儿童。虽然用于检测咽拭子中A组链球菌的快速诊断试剂盒并不完美，但如果检测结果为阳性，对从业者来说可能会有用，因为该检测的特异性很好。因此，快速检测呈阳性的咽炎患儿应立即接受治疗，以缩短发病期并降低非化脓性后遗症的风险。完成10天的治疗疗程后，如果患儿无症状，通常没有理由再对咽部进行培养。症状复发表明需要再次进行培养，并根据患者的依从性以及最初治疗所用药物，用苄星青霉素G或红霉素再次治疗。从携带者儿童的咽部清除A组链球菌通常是一项困难且不必要的任务。当有必要清除时，例如当携带者与患有风湿热的人有过接触时，应在青霉素治疗方案中添加利福平（表4）。
