tailieunhanh - Chapter 031. Pharyngitis, Sinusitis, Otitis, and Other Upper Respiratory Tract Infections (Part 11)

Pharyngitis: Treatment Antibiotic treatment of pharyngitis due to S. pyogenes confers numerous benefits, including a decrease in the risk of rheumatic fever. The magnitude of this benefit is fairly small, however, since rheumatic fever is now a rare disease, even among untreated patients. When therapy is started within 48 h of illness onset, however, symptom duration is also decreased. An additional benefit of therapy is the potential to reduce the spread of streptococcal pharyngitis, particularly in areas of overcrowding or close contact. Antibiotic therapy for acute pharyngitis is therefore recommended in cases where S. pyogenes is confirmed as the. | Chapter 031. Pharyngitis Sinusitis Otitis and Other Upper Respiratory Tract Infections Part 11 Pharyngitis Treatment Antibiotic treatment of pharyngitis due to S. pyogenes confers numerous benefits including a decrease in the risk of rheumatic fever. The magnitude of this benefit is fairly small however since rheumatic fever is now a rare disease even among untreated patients. When therapy is started within 48 h of illness onset however symptom duration is also decreased. An additional benefit of therapy is the potential to reduce the spread of streptococcal pharyngitis particularly in areas of overcrowding or close contact. Antibiotic therapy for acute pharyngitis is therefore recommended in cases where S. pyogenes is confirmed as the etiologic agent by rapid antigen-detection test or throat swab culture. Otherwise antibiotics should be given in routine cases only when another bacterial cause has been identified. Effective therapy for streptococcal pharyngitis consists of either a single dose of IM benzathine penicillin or a full 10-day course of oral penicillin Table 31-3 . Erythromycin can be used in place of penicillin although resistance to erythromycin among S. pyogenes strains in some parts of the world particularly Europe can prohibit the use of this drug. Newer and more expensive antibiotics are also active against streptococci but offer no greater efficacy than the above agents. Testing for cure is unnecessary and may reveal only chronic colonization. There is no evidence to support antibiotic treatment of group C or G streptococcal pharyngitis or of pharyngitis in which Mycoplasma or Chlamydophila has been recovered. Penicillin prophylaxis benzathine penicillin G million units IM every 3-4 weeks is indicated for patients at risk of recurrent rheumatic fever. Treatment of viral pharyngitis is entirely symptom-based except in infection with influenza virus or HSV. For influenza a number of therapeutic agents exist including amantadine rimantadine and .