eLetters to:

ARTICLES: Sarah Y. Park, Michael A. Gerber, Robert R. Tanz, John M. Hickner, James M. Galliher, Ilin Chuang, and Richard E. Besser Clinicians' Management of Children and Adolescents With Acute Pharyngitis Pediatrics 2006; 117: 1871-1878 [Abstract] [Full text] [PDF]

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eLetters published:

Throat cultures and CLIA

Leonard Levy, MD, FAAP   (3 June 2006)

pharyngitis revisited

Santosh V Kondekar, Dr Alpana Kondekar   (4 July 2006)

Throat cultures and CLIA 3 June 2006
Leonard Levy, MD, FAAP, Private practice of pediatrics none Send letter to journal: Re: Throat cultures and CLIA llevymd{at}aap.org Leonard Levy, MD, FAAP	To the editor, I have been in the private practice of pediatrics for 41 years, the last 22 as solo, and I have performed in-office throat cultures for GAS for all of that time. My experience is therefore both pre- and post-CLIA. My laboratory is CLIA-certified for throat (and urine) cultures. Many parents in my practice, rather than asking for antibiotics, request a throat culture for their sick children. My experience is that CLIA regulations regarding throat cultures for GAS are not particularly burdensome. I respectfully disagree with practitioners who have discontinued (or will not start) doing this simple and relatively inexpensive in-office test, citing CLIA as the reason. A throat culture for a patient with a sore throat is, after all, the gold standard. Very truly yours, Leonard Levy, MD, FAAP Pediatrics and Adolescent Medicine 6836 E. Genesee Street Fayetteville, NY 13066 Conflict of Interest: None declared
pharyngitis revisited 4 July 2006
Santosh V Kondekar, Lecturer Department of pediatrics King Edward Memorial Hospital Mumbai, Dr Alpana Kondekar Send letter to journal: Re: pharyngitis revisited drdoctor{at}hotmail.com Santosh V Kondekar, et al.	its true that most pediatric pharyngitis (below 2 yr age) are viral in origin, and bacteria including streptococci are commonly grown from pediatric throats even though the child is asymptomatic. So it becomes relatively unnecessary to perform throat cultures. "Viruses are isolated in approximately 40% of cases and include rhinovirus, adenovirus, parainfluenza virus, coxsackievirus, coronavirus, echovirus, herpes simplex virus, Epstein-Barr virus (mononucleosis), and cytomegalovirus. Primary bacterial pathogens that account for approximately 30% of cases of pharyngitis in children include GABHS (common), group C streptococci (uncommon), group G streptococci (uncommon), Neisseria gonorrhoeae (uncommon), Corynebacterium diphtheriae (rare), and Corynebacterium hemolyticum (extremely rare)." (ref:http://www.emedicine.com/EMERG/topic395.htm) Where as its easy to suspect a viral aetiology if some of the symptoms and or signs are present; viz: typical prodrome, cold, conjuctivitis, rhinorhea, wheezing etc; its absence doesnt truly mean its bacterial in origin. Bacterial sorethroat similarly has some of the characteristic findings like white patch/ granular inflammation /microabscess / associated acute lymphnode enlargement / lymph node tenderness, sinus tenderness, scarlet rash / membrane etc. But absence of these findings may help one suspect strongly a nonbacterial infection. True nothing is certain. The real reason to treat pharyngitis emperically and urgently; is the risk of its sequalae like glomerulonephritis, rheumatic fever and kawasaki disease. These risks are always there with even asymptomatic streptococcal pharyngitis; but documentation of streptococcal throat culture negative after therapy gives some clinical satisfaction in curtailing at least some of GABHS disease. I preer to stick only to conservative therapy in throat infections, mainly because most of throat and related infections in children below 2 years are viral origin and in children above 2 years, bacterial infections usually localise and also give enough time to observe/evaluate the course of disease. The therapy that works best is soothing normal saline nebulisation for throat relief, added to paracetamol for relief from fever and malaise for 2-3 days; keeping a close watch on development of any diagnostic signs for viral /bacterial aetiology, and if required, antibiotics; after a CBC / ASLO / culture as per the regional recommendations. Conflict of Interest: None declared