Dajani A S
Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.
Pediatr Infect Dis J. 1995 Apr;14(4 Suppl):S7-11.
Most authorities continue to recommend penicillin as the treatment of choice for group A streptococcal pharyngitis. If penicillin is used, 10 days of treatment are necessary to achieve a clinical and bacteriologic cure. The usually recommended penicillin V dose is 250 mg (400,000 IU) three times daily. Twice daily dosing is acceptable to some authorities if compliance is good. However, oral penicillin fails to eradicate group A streptococci from the pharynx in up to 17% of cases; in some studies 30% failure rates have been reported. Several European and United States studies indicate that a variety of oral cephalosporins, when used for 10 days, are significantly superior to penicillin V in eradicating group A streptococci from the pharynx. For example cefpodoxime proxetil given twice daily for 10 days is comparable to penicillin V given three times daily for 10 days in achieving a clinical cure and appears to be significantly superior to penicillin in eradicating group A streptococci from the pharynx. Preliminary studies from Europe and the United States strongly suggest that 5-day therapy with cefpodoxime (or other selected oral cephalosporins) is at least as effective, clinically and microbiologically, as 10-day therapy with penicillin V. Further clinical trials are warranted to confirm the adequacy of 5-day treatment and to assess the efficacy of cefpodoxime and other agents in preventing rheumatic fever.
大多数权威机构仍推荐青霉素作为A组链球菌性咽炎的首选治疗药物。如果使用青霉素，需要10天的治疗才能实现临床和细菌学治愈。通常推荐的青霉素V剂量是每日三次，每次250毫克（40万国际单位）。如果依从性良好，一些权威机构也接受每日两次给药。然而，口服青霉素在高达17%的病例中无法从咽部根除A组链球菌；在一些研究中，报告的失败率为30%。几项欧洲和美国的研究表明，多种口服头孢菌素在使用10天时，在从咽部根除A组链球菌方面明显优于青霉素V。例如，头孢泊肟酯每日两次给药10天，在实现临床治愈方面与青霉素V每日三次给药10天相当，并且在从咽部根除A组链球菌方面似乎明显优于青霉素。来自欧洲和美国的初步研究强烈表明，头孢泊肟（或其他选定的口服头孢菌素）5天疗法在临床和微生物学方面至少与青霉素V 10天疗法一样有效。有必要进行进一步的临床试验，以确认5天治疗的充分性，并评估头孢泊肟和其他药物预防风湿热的疗效。
