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The desired outcomes are prevention of acute rheumatic fever, prevention of suppurative complications, improvement of clinical symptoms and signs, reduction in transmission of group A β-hemolytic streptococci to close contacts of patients, and minimization of potential adverse effects of inappropriate antimicrobial therapy.
Full Answer
What are the treatment options for Group A beta-hemolytic streptococcus (GBS)?
The treatment of the carrier state of group A beta-hemolytic streptococci with clindamycin. Chemotherapy. 1981;27(05):360–367. [ PubMed] [ Google Scholar] 80. Stillerman M, Isenberg H D, Facklam R R. Streptococcal pharyngitis therapy: comparison of clindamycin palmitate and potassium phenoxymethyl penicillin.
What is the pathophysiology of Group A β-hemolytic streptococcus (BBS) infection?
They may be colonized by group A β-hemolytic streptococci for several months and, during that period, may experience episodes of intercurrent viral pharyngitis. Testing may reveal that these patients have group A β-hemolytic streptococci in their pharynxes, and they appear to have acute streptococcal pharyngitis.
Which antibiotics are used to treat chronic Streptococcus infections?
Several antimicrobials have been found to be more effective than penicillin or amoxicillin in eliminating chronic streptococcal carriage. These include clindamycin 87 and the combination of penicillin (IM or PO) and rifampin. 83
When are antibiotics indicated in the treatment of Group A streptococcus pharyngitis?
Moreover, group A streptococcal pharyngitis is the only commonly occurring form of acute pharyngitis for which antibiotic therapy is definitely indicated. Therefore, for a patient with acute pharyngitis, the clinical decision that usually needs to be made is whether the pharyngitis is attributable to group A streptococci.
How long does it take for penicillin to cure Gabhs?
Treatment duration with penicillin should be 10 days to optimize cure in GABHS infections.
Is penicillin a first line antibiotic?
Penicillin currently is recommended by the American Academy of Pediatrics and American Heart Association as first-line therapy for GABHS infections; erythromycin is recommended for those allergic to penicillin. Virtually all patients improve clinically with penicillin and other antibiotics.
What test is done to determine if streptococci are present in the pharynx?
Therefore, unless the physician is able with confidence to exclude the diagnosis of streptococcal pharyngitis on epidemiological and clinical grounds, a laboratory test should be done to determine whether group A streptococci are present in the pharynx.
What is the best treatment for streptococcal pharyngitis?
A number of antibiotics have been shown to be effective in treating group A streptococcal pharyngitis.
What is a positive RADT?
A positive result of either throat culture or RADT provides adequate confirmation of the presence of group A β-hemolytic streptococci in the pharynx. However, for children and adolescents, a negative RADT result should be confirmed with a throat culture result, unless the physician has ascertained in his or her own practice that the RADT used is comparable to a throat culture. Because of the epidemiological features of acute pharyngitis in adults (e.g., low incidence of streptococcal infection and extremely low risk of rheumatic fever), diagnosis of this infection in adults on the basis of the results of an RADT, without confirmation of negative RADT results by negative results of culture, is an acceptable alternative to diagnosis on the basis of throat culture results. The generally high specificity of RADTs should minimize overprescription of antimicrobials for treatment of adults (A-II).
What is group A pharyngitis?
Acute group A β-hemolytic streptococcal pharyngitis has certain characteristic epidemiological and clinical features [ 8, 16, 17] ( table 3 ). The disorder is primarily a disease of children 5–15 years of age, and, in temperate climates, it usually occurs in the winter and early spring. Patients with group A β-hemolytic streptococcal pharyngitis commonly present with sore throat (generally of sudden onset), severe pain on swallowing, and fever. Headache, nausea, vomiting, and abdominal pain may also be present, especially in children [ 8 ]. On examination, patients have tonsillopharyngeal erythema, with or without exudates, and tender, enlarged anterior cervical lymph nodes (lymphadenitis). Other findings may include a beefy, red, swollen uvula; petechiae on the palate; excoriated nares (especially in infants); and a scarlatiniform rash. However, none of these findings is specific for group A β-hemolytic streptococcal pharyngitis. Conversely, the absence of fever or the presence of clinical features such as conjunctivitis, cough, hoarseness, coryza, anterior stomatitis, discrete ulcerative lesions, viral exanthem, and diarrhea strongly suggest a viral rather than a streptococcal etiology.
Why exclude streptococcal pharyngitis?
Therefore, it is extremely important that physicians exclude the diagnosis of group A streptococcal pharyngitis to prevent inappropriate administration of antimicrobials to large numbers of patients with pharyngitis.
Is RADT necessary for asymptomatic pharyngitis?
Routine performance of throat culture (or RADT) for asymptomatic persons after they have completed a course of antibiotic therapy is not necessary except in special circumstances (see the section “Recommendations” in Diagnosis of Group A Streptococcal Pharyngitis).
Can a group A pharynx colonize?
They may be colonized by group A β-hemolytic streptococci for several months and, during that period, may experience episodes of intercurrent viral pharyngitis. Testing may reveal that these patients have group A β-hemolytic streptococci in their pharynxes, and they appear to have acute streptococcal pharyngitis.
