Pichichero M E, Green J L, Francis A B, Marsocci S M, Murphy A M, Hoeger W, Noriega C, Sorrento A, Gootnick J
Elmwood Pediatric Group, Rochester, NY 14642, USA.
Pediatr Infect Dis J. 1998 Sep;17(9):809-15. doi: 10.1097/00006454-199809000-00012.
To examine the epidemiology and treatment of group A beta-hemolytic streptococcal (GABHS) recurrent tonsillopharyngitis in private pediatric practice.
This was a retrospective chart review study covering the time span 1975 to 1996 involving 2140 GABHS episodes. Diagnosis was based on acute clinical symptoms and laboratory confirmation (throat culture or positive rapid antigen detection test) of GABHS.
Eighty percent (n=1721) of the episodes evaluated were treated with penicillin or amoxicillin; 352 (20.5%) of these were followed by a recurrence within 30 days and 519 (30.2%) within 60 days. GABHS recurrences within 30 days after penicillin/amoxicillin treatment rose from 9% in 1975 to 1979 to 25.9% in 1980 to 1984, 24.2% in 1985 to 1989, 22.4% in 1990 to 1994 and 25.9% in 1995 to 1996 (P < 0.02); 53.4% of the recurrences were associated with symptoms and signs of GABHS tonsillopharyngitis, 9.9% were asymptomatic and 36.7% could not be classified. Recurrences within 60 days after penicillin/ amoxicillin treatment rose from 10.7% in 1975 to 1979 to 38.7% in 1980 to 1984, 39.0% in 1985 to 1989, 31.7% in 1990 to 1994 and 37.5% in 1995 to 1996 (P < 0.001). Recurrent GABHS infections occurred more frequently in younger children (1 to 8 years of age, 21.3% recurrence rate) than in adolescents (13 to 19 years, 5% recurrence rate; P=0.002). Recurrences within 30 days occurred more often after therapy with penicillin (21.8% of 1581 episodes) than with cephalosporins (8.6% of 254 episodes) (P < 0.0001) or with macrolides (14.0% of 143 episodes, P=0.04). Recurrence rates were unaffected by patient gender or season of the year.
Recurrent GABHS infections occur more frequently in the 1990s than the 1970s, occur more frequently in children younger than 8 years of age than in adolescents and occur more frequently after penicillin treatment than with alternative antibiotic therapy.
研究私立儿科诊所中A组β溶血性链球菌（GABHS）复发性扁桃体咽炎的流行病学及治疗情况。
这是一项回顾性图表审查研究，涵盖1975年至1996年期间的2140例GABHS病例。诊断基于急性临床症状以及GABHS的实验室确诊（咽拭子培养或快速抗原检测试验呈阳性）。
80%（n = 1721）的评估病例接受了青霉素或阿莫西林治疗；其中352例（20.5%）在30天内复发，519例（30.2%）在60天内复发。青霉素/阿莫西林治疗后30天内的GABHS复发率从1975年至1979年的9%升至1980年至1984年的25.9%，1985年至1989年为24.2%，1990年至1994年为22.4%，1995年至1996年为25.9%（P < 0.02）；53.4%的复发与GABHS扁桃体咽炎的症状和体征相关，9.9%无症状，36.7%无法分类。青霉素/阿莫西林治疗后60天内的复发率从1975年至1979年的10.7%升至1980年至1984年的38.7%，1985年至1989年为39.0%，1990年至1994年为31.7%，1995年至1996年为37.5%（P < 0.001）。复发性GABHS感染在年幼儿童（1至8岁，复发率21.3%）中比青少年（13至19岁，复发率5%；P = 0.002）更常见。30天内的复发在青霉素治疗后（1581例中的21.8%）比头孢菌素治疗后（254例中的8.6%）更频繁（P < 0.0001），也比大环内酯类治疗后（143例中的14.0%，P = 0.04）更频繁。复发率不受患者性别或季节影响。
20世纪90年代复发性GABHS感染比20世纪70年代更常见，在8岁以下儿童中比青少年更常见，青霉素治疗后比其他抗生素治疗更常见。
