Majeed H A, al-Doussary L, Moussa M M, Yusuf A R, Suliman A H
Department of Pediatrics, Faculty of Medicine, University of Kuwait.
Ann Trop Paediatr. 1993;13(1):65-72. doi: 10.1080/02724936.1993.11747626.
The impact of introducing the rapid antigen detecting test for the diagnosis of group A streptococcal pharyngitis in primary care centres and the direct and comprehensive cost-effectiveness of four alternative strategies for the management of group A streptococcal pharyngitis and the prevention of rheumatic fever were assessed in a 1-year prospective randomized study, carried out in children between the ages of 5 and 14 years. Data from the study showed that the test was easy to perform and reliable when introduced as a service in primary care. The strategy of using the rapid antigen detecting test and a 10-day oral penicillin course for diagnosis and treatment proved to be the safest and most cost-effective. If compliance with a 10-day course of oral penicillin is unlikely to be achieved, the strategy of introducing the test and treatment by intramuscular benzathin penicillin G proved to be the second best cost-effective alternative. In developing countries, where acute rheumatic fever is still common and the cost of the test and a 10-day course of penicillin may prove to be formidable, a strategy of treating all children with pharyngitis with intramuscular benzathin penicillin G seems to be the most cost-effective. The strategy of diagnosing group A streptococcal pharyngitis on clinical grounds proved to be the worst.
在一项针对5至14岁儿童开展的为期1年的前瞻性随机研究中，评估了在基层医疗中心引入快速抗原检测用于诊断A组链球菌性咽炎的影响，以及四种用于管理A组链球菌性咽炎和预防风湿热的替代策略的直接和综合成本效益。该研究数据表明，当作为基层医疗服务引入时，该检测易于操作且可靠。使用快速抗原检测和10天口服青霉素疗程进行诊断和治疗的策略被证明是最安全且最具成本效益的。如果不太可能实现10天口服青霉素疗程的依从性，引入检测并采用肌内注射苄星青霉素G进行治疗的策略被证明是第二好的具有成本效益的选择。在急性风湿热仍然常见且检测和10天青霉素疗程的成本可能很高的发展中国家，用肌内注射苄星青霉素G治疗所有咽炎儿童的策略似乎是最具成本效益的。基于临床依据诊断A组链球菌性咽炎的策略被证明是最差的。
