Pichichero M E
University of Rochester Medical Center, Elmwood Pediatric Group, Rochester, New York 14642, USA.
Postgrad Med. 1997 Jan;101(1):205-6, 209-12, 215-8, passim. doi: 10.3810/pgm.1997.01.150.
In this discussion of recurrent group A streptococcal tonsillopharyngitis, the author notes that even at the peak of the streptococcal infection season, not more than 30% to 40% of children with sore throats actually have group A streptococci as the cause. Thus, it is vital to confirm clinical diagnosis of group A streptococcal tonsillopharyngitis with laboratory tests. When patients have recurrent infections with group A streptococci, possible causes include noncompliance, bacterial resistance, repeated exposure, alteration of the throat's microbial ecology, suppression of antibody response due to previous antibiotic therapy, and treatment failure. When noncompliance is an issue, an injection of penicillin G benzathine may be appropriate. In other circumstances, pharmacologic options for treatment of recurrent group A streptococcal tonsillopharyngitis include macrolides, clindamycin hydrochloride, rifampin (in combination with a second agent), and oral cephalosporins. If a patient has six or seven recurrences over 1 or 2 years despite antibiotic treatment, tonsillectomy should be considered.
在本次关于复发性A组链球菌性扁桃体咽炎的讨论中，作者指出，即使在链球菌感染季节的高峰期，咽痛儿童中实际由A组链球菌引起的也不超过30%至40%。因此，通过实验室检查来确诊A组链球菌性扁桃体咽炎的临床诊断至关重要。当患者出现A组链球菌反复感染时，可能的原因包括不依从、细菌耐药、反复接触、咽喉微生物生态改变、既往抗生素治疗导致抗体反应受抑制以及治疗失败。当存在不依从问题时，注射苄星青霉素G可能是合适的。在其他情况下，治疗复发性A组链球菌性扁桃体咽炎的药物选择包括大环内酯类、盐酸克林霉素、利福平（与第二种药物联合使用）以及口服头孢菌素。如果患者在1或2年内尽管接受了抗生素治疗仍复发六到七次，则应考虑行扁桃体切除术。
