All of the following are guidelines for constructive reframing except:
Advanced Search Executive Summary The objective of this practice guideline is to provide recommendations for the accurate diagnosis and optimal treatment of group A streptococcal pharyngitis in children and adults.
This statement is an update of the practice guideline published in [ 1 ] and takes into account relevant research published since that time.
A major substantive change is the acceptance of negative results of rapid antigen detection testing RADT for exclusion of acute streptococcal pharyngitis, without the previously mandated confirmation with a negative culture result, provided certain criteria are met, as detailed below.
Acute pharyngitis is one of the most frequent illnesses for which pediatricians, internists, and other primary care physicians are consulted. Although the group A streptococcus is the most common bacterial cause of acute pharyngitis, only a small percentage of patients with this condition are infected by group A streptococci.
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.
The signs and symptoms of group A streptococcal and other most frequently viral pharyngitides overlap broadly. 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.
The test may be either culture of a throat swab specimen or an RADT, which detects the presence of group A streptococcal carbohydrate on a throat swab.
Because of the epidemiological features of acute pharyngitis in adults e.
The generally high specificity of RADTs should minimize overprescription of antimicrobials for treatment of adults. Figure 1 View large Download slide Diagnosis and management of acute pharyngitis.
The algorithm applies to uncomplicated cases of acute pharyngitis. Additional diagnostic and therapeutic measures may be necessary for patients with suppurative complications e. Patients with acute streptococcal pharyngitis should receive therapy with an antimicrobial agent in a dose and for a duration that is likely to eradicate the infecting organism from the pharynx.
A number of antibiotics have been shown to be effective in treating group A streptococcal pharyngitis. These include penicillin and its congeners such as ampicillin, amoxicillin, and the semisynthetic penicillinsas well as numerous cephalosporins and macrolides and clindamycin.
Penicillin, however, remains the agent of choice because of its proven efficacy, safety, narrow spectrum, and its low cost. Amoxicillin is often used in place of oral penicillin V to treat young children; the efficacy appears to be equal. This choice is primarily related to acceptance of the taste of the suspension.
Intramuscular administration of benzathine penicillin G is preferred for patients who are unlikely to complete a full day course of oral therapy. Erythromycin is a suitable alternative for patients allergic to penicillin.
However, no definitive results from comprehensive studies are available to allow final evaluation of these proposed shorter courses of oral antibiotic therapy [ 4 ], which, therefore, cannot be recommended at this time.
Moreover, these antibiotics have a much broader spectrum than does penicillin, and most, even when administered for short courses, are more expensive.
Except under special circumstances, neither repeat bacteriologic testing culture or RADT of patients who are asymptomatic after a course of antimicrobial therapy nor routine testing of asymptomatic household contacts of a patient with group A streptococcal pharyngitis is recommended.
A small percentage of patients will have a recurrence of acute pharyngitis associated with results of throat culture or RADT that are positive for group A streptococci within a short time after completion of a course of antimicrobial therapy.
Such episodes may be treated with an antimicrobial agent appropriate for treatment of the initial illness. If the previous treatment was with an oral agent and compliance is in question, a second course of intramuscular benzathine penicillin G therapy should be considered.
When multiple episodes occur over the course of months or years, it may be difficult to differentiate viral pharyngitis in a Streptococcus.Weather is the state of the atmosphere, describing for example the degree to which it is hot or cold, wet or dry, calm or stormy, clear or cloudy.
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