Streptococcal pharyngitis: A review of pathophysiology, diagnosis, and management

Editorial Policy

“…Throughout the article the reader is referred to several recent reviews of the clinical manifestations and treatment of these syndromes. mens would be culture-positive, the clinical diagnosis of streptococcal pharyngitis is unreliable [12][13][14][15]. Probability estimates are perhaps most useful in deciding who should not be tested or treated empirically while further diagnostic data are awaited.…”

“…Probability estimates are perhaps most useful in deciding who should not be tested or treated empirically while further diagnostic data are awaited. For example, the presence ofcough, rhinorrhea, sneezing, and hoarseness has about an 80% negative predictive value for the presence of streptococcal pharyngitis, especially in the absence of fever, exudate, and cervical adenopathy [13,14,16].…”

The Impact of Dosing Frequency on the Efficacy of 10-Day Penicillin or Amoxicillin Therapy for Streptococcal Tonsillopharyngitis: A Meta-analysis

“…Carriers are not at risk for acute rheumatic fever, but if treatment with a full course of penicillin is nevertheless given, the carrier state often persists. 22 The existence of streptococcal carriers underlines the importance of using strict clinical criteria when evaluating patients for enrollment in trials. For example, inadvertent inclusion of streptococcal carriers who happen to have an acute viral pharyngitis in a randomized trial would lead to nondifferential misclassification and result in type II error (that is, concluding that a difference in efficacy does not exist when it in fact does).…”

“…24 A list of desirable study characteristics was assembled from various discussions about study design quality in the context of both clinical trials evaluating antibiotic treatment of streptococcal tonsillopharyngitis as well as clinical trials in general. 21,22,25,26 The presence or absence of the following characteristics was noted for each study.…”

“…24 A list of desirable study characteristics was assembled from various discussions about study design quality in the context of both clinical trials evaluating antibiotic treatment of streptococcal tonsillopharyngitis as well as clinical trials in general. 21,22,25,26 The presence or absence of the following characteristics was noted for each study.Steps taken to improve diagnostic accuracy: 1) Study performed between December and May; 2) Subjects under 3 years of age excluded from study; 3) Diagnosis made on basis of signs and symptoms consistent with streptococcal tonsillopharyngitis (pharyngeal pain, dysphagia, fever, malaise, headache, abdominal pain, vomiting, erythematous pharynx, patchy exudate on posterior pharynx or tonsils, palatal petechiae, and enlarged and tender anterior cervical lymph nodes) and signs and symptoms consistent with viral pharyngitis not included (rhinorrhea, cough, hoarseness, conjunctivitis, and diarrhea). Steps to decrease and distinguish subsequent reinfection after cure from persistent infection: 4) Data available on follow-up cultures performed fewer than 14 days after completing treatment; 5) Comparison of pretreatment and posttreatment GABHS serotypes for subjects with positive follow-up culture results.…”