Guggenbichler J P
Department of Paediatrics, Universitätsspital, Erlangen, Germany.
Drugs. 1994;47 Suppl 3:27-33; discussion 34. doi: 10.2165/00003495-199400473-00006.
Between 15 and 35% of pharyngeal infections are attributable to Group A beta-haemolytic streptococci. Streptococcal pharyngitis is one of the most common infections in adolescents and children. A specific diagnosis of pharyngitis can be obtained only by isolating organisms in culture. The current treatment of choice for streptococcal pharyngitis/tonsillitis is a 10-day course of phenoxymethylpenicillin (penicillin V); however, unresolved problems concerning the use of penicillin include the timing of therapy, appropriate therapy for treatment failures, chronic carriers and those with frequent recurrences. In addition, failure rates of 10 to 35% have been reported with oral phenoxymethylpenicillin. Effective treatment alternatives in this indication include oral cephalosporin agents or penicillin/beta-lactamase inhibitor combinations. The oral cephalosporins offer the advantage of an improved pharmacokinetic profile, once- or twice-daily administration, a shorter (7-day) regimen, and a low incidence of adverse effects, although these advantages must be balanced against the broad spectrum of these agents (broader than is necessary) and their cost. Clinical trials conducted with cefetamet pivoxil, a new oral third generation cephalosporin, in both adults and children with pharyngitis/tonsillitis indicate that this agent offers an effective alternative for phenoxymethylpenicillin in this indication.
15%至35%的咽部感染由A组β溶血性链球菌引起。链球菌性咽炎是青少年和儿童中最常见的感染之一。咽炎的特异性诊断只能通过在培养物中分离病原体来获得。目前链球菌性咽炎/扁桃体炎的首选治疗方法是使用苯氧甲基青霉素（青霉素V）进行为期10天的疗程；然而，与青霉素使用相关的未解决问题包括治疗时机、治疗失败的适当治疗方法、慢性携带者以及复发频繁者的治疗。此外，口服苯氧甲基青霉素的失败率据报道为10%至35%。该适应症的有效替代治疗方法包括口服头孢菌素类药物或青霉素/β-内酰胺酶抑制剂组合。口服头孢菌素具有药代动力学特性改善、每日给药一次或两次、疗程较短（7天）以及不良反应发生率低的优点，尽管这些优点必须与这些药物的广谱性（比必要的更广）及其成本相权衡。对一种新型口服第三代头孢菌素头孢他美酯在咽炎/扁桃体炎成人和儿童中进行的临床试验表明，该药物在该适应症中为苯氧甲基青霉素提供了一种有效的替代选择。
