Hedges J R, Lowe R A
Ann Emerg Med. 1986 Mar;15(3):312-6. doi: 10.1016/s0196-0644(86)80573-x.
The traditional use of the throat culture to guide treatment of potential streptococcal pharyngitis recently has been questioned because of the following facts: antibiotic therapy within the first 48 hours of illness reduces the severity and symptoms of streptococcal pharyngitis; more rapid treatment of streptococcal pharyngitis may be more effective in prevention of rheumatic fever; clinical and Gram stain criteria can identify individuals with a high probability of a positive throat culture; new latex agglutination tests can identify within minutes individuals with a high probability of a positive throat culture; the throat culture may be falsely negative in individuals with partially treated pharyngitis, an inadequately swabbed or plated specimen, or an improperly read culture plate; and incomplete patient followup increases the true societal cost of traditional therapy based on throat culture results. These issues suggest that a sufficiently accurate screening test for guiding antibiotic therapy at the initial visit may be more clinically beneficial and cost effective than recalling all positive throat culture patients for antibiotic therapy. Nonetheless, a throat culture remains important when a screening test of a patient with suspected streptococcal pharyngitis is negative. Indications for culturing pharyngitis for other potential pathogens also are discussed.
由于以下事实，传统上利用咽拭子培养来指导潜在的链球菌性咽炎治疗的方法最近受到了质疑：在发病后的头48小时内进行抗生素治疗可减轻链球菌性咽炎的严重程度和症状；对链球菌性咽炎进行更快速的治疗在预防风湿热方面可能更有效；临床和革兰氏染色标准能够识别咽拭子培养结果很可能呈阳性的个体；新的乳胶凝集试验能够在数分钟内识别咽拭子培养结果很可能呈阳性的个体；在咽炎部分接受治疗、拭子取样或接种标本不充分或培养板读数不当的个体中，咽拭子培养结果可能出现假阴性；而且对患者随访不完整会增加基于咽拭子培养结果的传统治疗的实际社会成本。这些问题表明，在初次就诊时，一种足够准确的用于指导抗生素治疗的筛查试验可能比召回所有咽拭子培养结果呈阳性的患者进行抗生素治疗在临床上更有益且更具成本效益。尽管如此，当对疑似链球菌性咽炎患者的筛查试验结果为阴性时，咽拭子培养仍然很重要。本文还讨论了对咽炎培养以检测其他潜在病原体的指征。
