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The Treatment of Streptococcal Pharyngitis

Alberto Odio, MD
JAMA. 1987;257(2):186. doi:10.1001/jama.1987.03390020052013.
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To the Editor.—  The review by Colonel Bass of the treatment of streptococcal pharyngitis1 gives us a helpful historical perspective but skirts some treatment issues that confront physicians today.We can no longer expect nearly all patients with streptococcal pharyngitis who are properly treated to have negative cultures and be asymptomatic after therapy. Today, 19% to 37% of patients have positive posttreatment cultures.2 Although some feel that these patients are carriers and not a major concern, recent studies (and my clinical experience) suggest that a third of these bacteriologic failures are true infections and true treatment failures, based on antibody titer rise and return of symptoms.3 Clinically, however, one cannot distinguish a true treatment failure from a carrier whose renewed symptoms are from a viral infection. How then should symptomatic treatment failures be managed?There are patients who develop recurrent streptococcal infections despite appropriate treatment. Most of


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