PEDIATRICS Vol. 101 No. 1 Supplement January 1998, pp. 171-174
Pharyngitis
Principles of Judicious Use of Antimicrobial Agents
,
, and
From the * Childhood and Respiratory Diseases Branch, National
Centers for Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, Georgia; Kaiser Permanente, Panorama City,
California; § Northwest Family Medicine, Seattle, Washington; and
Connecticut Children;s Medical Center, Hartford, Connecticut.
Accurate diagnosis of group A streptococcal
pharyngitis and appropriate antimicrobial therapy
are important, particularly to prevent nonsuppurative sequelae such as
rheumatic fever. Most episodes of sore throat, however, are caused by
viral agents. Clinical findings cannot reliably differentiate
streptococcal from viral pharyngitis and most physicians tend to
overestimate the probability of a streptococcal infection based on
history and physical examination alone. Therefore, diagnosis should be based on results of a throat culture or an antigen-detection test with
throat culture backup. Presumptively starting therapy pending results
of a culture is discouraged because treatment often continues despite a
negative test result. Other bacterial causes of pharyngitis are
uncommon and often can be diagnosed based on nonpharyngeal findings.
Penicillin remains the drug of choice for streptococcal pharyngitis
because of its effectiveness, relatively narrow spectrum, and low cost.
No group A streptococci are resistant to 
-lactam antibiotics. High
rates of resistance to macrolides has been documented in several areas;
in Finland, decreased national rates of macrolide use led to a decline
in the proportion of macrolide-resistant group A streptococci.
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