不同青霉素 V 策略治疗 A 组链球菌性咽扁桃体炎的临床病程，按 Centor 评分 3 分和 4 分分组：初级保健中的前瞻性研究。

Clinical course of pharyngotonsillitis with group A streptococcus treated with different penicillin V strategies, divided in groups of Centor Score 3 and 4: a prospective study in primary care.

机构信息

Futurum, Region Jönköping County, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.

Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Lund, Sweden.

出版信息

BMC Infect Dis. 2022 Nov 11;22(1):840. doi: 10.1186/s12879-022-07830-4.

DOI:10.1186/s12879-022-07830-4

PMID:36368940

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9652839/

Abstract

BACKGROUND

Sore throat is a common reason for prescribing antibiotics in primary care, and 10 days of treatment is recommended for patients with pharyngotonsillitis with group A streptococcus (GAS). Our group recently showed that penicillin V (PcV) four times daily for 5 days was non-inferior in clinical outcome to PcV three times daily for 10 days. This study compares duration, intensity of symptoms, and side effects in patients with a Centor Score (CS) of 3 or 4 respectively, after treatment with PcV for 5 or 10 days and evaluates whether all patients with pharyngotonsillitis with a CS of 3 or 4 should be treated for 5 days or if severity of symptoms or CS suggest a longer treatment period.

METHOD

Data on symptoms and recovery from patient diaries from 433 patients included in a RCT comparing PcV 800 mg × 4 for 5 days or PcV 1 g × 3 for 10 days was used. Patients six years and older with CS-3 or CS-4 and positive rapid antigen detection test for GAS-infection were grouped based on CS and randomized treatment. Comparisons for categorical variables were made with Pearson's chi-squared test or Fisher's exact test. Continuous variables were compared with the Mann-Whitney U test.

RESULTS

Patients with CS-3 as well as patients with CS-4 who received PcV 800 mg × 4 for 5 days self-reported that they recovered earlier compared to patients with CS-3 or CS-4 who received treatment with PcV 1 g × 3 for 10 days. In addition, the throat pain as single symptom was relieved 1 day earlier in patients with CS-4 and 5 days of treatment compared to patients with CS-4 and 10 days of treatment. No differences in side effects between the groups were found.

CONCLUSION

Intense treatment with PcV four times a day for 5 days seems clinically beneficial and strengthens the suggestion that the 4-dose regimen with 800 mg PcV for 5 days may be the future treatment strategy for GAS positive pharyngotonsillitis irrespectively of CS-3 or CS-4. Trail registration ClinicalTrials.gov ID: NCT02712307 (3 April 2016).

摘要

背景

在初级保健中，喉咙痛是开抗生素处方的常见原因，对于 A 组链球菌（GAS）咽扁桃体炎患者，建议治疗 10 天。我们的研究小组最近表明，青霉素 V（PcV）每天四次，连续 5 天治疗与每天三次，连续 10 天治疗相比，在临床结局方面无差异。本研究比较了使用 PcV 治疗 5 天或 10 天后，分别有 Centor 评分（CS）3 分或 4 分的患者的持续时间、症状强度和副作用，并评估所有 CS 为 3 分或 4 分的咽扁桃体炎患者是否均应治疗 5 天，或者症状或 CS 的严重程度是否提示需要更长的治疗时间。

方法

使用来自比较 PcV800mg×4 治疗 5 天与 PcV1g×3 治疗 10 天的 RCT 中 433 名患者的症状和恢复情况的患者日记数据。将 6 岁及以上 CS-3 或 CS-4 且 GAS 感染快速抗原检测阳性的患者按 CS 分组并进行随机治疗。对分类变量进行 Pearson's chi-squared 检验或 Fisher's exact 检验。连续变量采用 Mann-Whitney U 检验进行比较。

结果

CS-3 患者和接受 PcV800mg×4 治疗 5 天的 CS-4 患者自我报告恢复时间早于 CS-3 或 CS-4 患者接受 PcV1g×3 治疗 10 天的患者。此外，CS-4 患者中，与接受 10 天治疗的患者相比，单一症状咽痛缓解时间早 1 天，5 天治疗的患者中，与接受 10 天治疗的患者相比，咽痛缓解时间早 5 天。两组之间未发现不良反应的差异。