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ARTICLE |

The Treatment of Streptococcal Pharyngitis FREE

Alberto Odio, MD
[+] Author Affiliations

Edited by Drummond Rennie, MD, Senior Contributing Editor; Sharon Iverson, Assistant Editor.


JAMA. 1987;257(2):186-186. 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

REFERENCES

Bass JW:  Treatment of streptococcal pharyngitis revisited . JAMA 1986;;256:740-743.
Kaplan EL, Gastanaduy AS, Huwe BB:  The role of the carrier in treatment failures after antibiotic therapy for group A streptococci in the upper respiratory tract . J Lab Clin Med 1981;;98:326-335.
Gerber MA, Spadaccini LJ, Wright LL, et al:  Twice-daily penicillin in the treatment of streptococcal pharyngitis . AJDC 1985;;139:1145-1148.
Komaroff AL, Aronson MD, Pass TM, et al:  Serologic evidence of chlamydial and mycoplasmal pharyngitis in adults . Science 1983;;222:927-929.
Krober MS, Bass JW, Michels GN:  Streptococcal pharyngitis: Placebo-controlled double-blind evaluation of clinical response to penicillin therapy . JAMA 1985;;253: 1271-1274.
Nelson JD:  The effect of penicillin therapy on the symptoms and signs of streptococcal pharyngitis . Pediatr Infect Dis 1984;;3:10-13.
Randolph MF, Gerber MA, DeMeo KK, et al:  Effect of antibiotic therapy on the clinical course of streptococcal pharyngitis . J Pediatr 1985;;106:870-875.
Odio A:  Diagnosis and treatment of streptococcal pharyngitis . JAMA 1985;;254:908-909.

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Bass JW:  Treatment of streptococcal pharyngitis revisited . JAMA 1986;;256:740-743.
Kaplan EL, Gastanaduy AS, Huwe BB:  The role of the carrier in treatment failures after antibiotic therapy for group A streptococci in the upper respiratory tract . J Lab Clin Med 1981;;98:326-335.
Gerber MA, Spadaccini LJ, Wright LL, et al:  Twice-daily penicillin in the treatment of streptococcal pharyngitis . AJDC 1985;;139:1145-1148.
Komaroff AL, Aronson MD, Pass TM, et al:  Serologic evidence of chlamydial and mycoplasmal pharyngitis in adults . Science 1983;;222:927-929.
Krober MS, Bass JW, Michels GN:  Streptococcal pharyngitis: Placebo-controlled double-blind evaluation of clinical response to penicillin therapy . JAMA 1985;;253: 1271-1274.
Nelson JD:  The effect of penicillin therapy on the symptoms and signs of streptococcal pharyngitis . Pediatr Infect Dis 1984;;3:10-13.
Randolph MF, Gerber MA, DeMeo KK, et al:  Effect of antibiotic therapy on the clinical course of streptococcal pharyngitis . J Pediatr 1985;;106:870-875.
Odio A:  Diagnosis and treatment of streptococcal pharyngitis . JAMA 1985;;254:908-909.
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