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PubMed1997

Sore throat after sore throat after sore throat. Are you asking the critical questions?

In this discussion of recurrent group A streptococcal tonsillopharyngitis, the author notes that even at the peak of the streptococcal infection season, not more than 30% to 40% of children with sore throats actually have group A streptococci as the cause. Thus, it is vital to confirm clinical diagnosis of group A streptococcal tonsillopharyngitis with laboratory tests. When patients have recurrent infections with group A streptococci, possible causes include noncompliance, bacterial resistance, repeated exposure, alteration of the throat's microbial ecology, suppression of antibody response due to previous antibiotic therapy, and treatment failure. When noncompliance is an issue, an injection of penicillin G benzathine may be appropriate. In other circumstances, pharmacologic options for treatment of recurrent group A streptococcal tonsillopharyngitis include macrolides, clindamycin hydrochloride, rifampin (in combination with a second agent), and oral cephalosporins. If a patient has six or seven recurrences over 1 or 2 years despite antibiotic treatment, tonsillectomy should be considered.

Adult↗

PubMed2000

Antibiotics for sore throat.

BACKGROUND: Sore throat is a very common reason for people to attend for medical care. Sore throat is a disease that remits spontaneously, that is, 'cure' is not dependant on treatment. Nonetheless primary care doctors commonly prescribe antibiotics for sore throat and other upper respiratory tract infections. OBJECTIVES: To assess the benefits of antibiotics in the management of sore throat. SEARCH STRATEGY: Systematic search of the literature from 1945 to 1999, using electronic searches of MEDLINE (using the keywords, "pharyngitis", "sore throat" and "tonsillitis") after 1966, the Cochrane Library, the Cochrane collection of hand-searched trials, and the reference sections of the articles identified. Abstracts of identified articles were used to determine which studies were trials. SELECTION CRITERIA: Trials of antibiotic against control with either measures of the typical symptoms (throat soreness, headache or fever), or complications (suppurative and non-suppurative) of sore throat. DATA COLLECTION AND ANALYSIS: RevMan 4.0.3 MAIN RESULTS: A total number of 10,484 cases of sore throat have been studied. 1. Non-suppurative complications There was a trend for protection against acute glomerulonephritis by antibiotics, but insufficient cases were recorded to be sure of this effect. Several studies found benefit from antibiotics for acute rheumatic fever, which reduced this complication to less than one third (OR = 0.30; 95% CI = 0.20-0.45). 2. Suppurative complications Antibiotics reduced the incidence of acute otitis media to about one quarter of that in the placebo group (OR = 0.22; 95% CI = 0.11-0.43) and reduced the incidence of acute sinusitis to about one half of that in the placebo group (OR = 0.46; 95% CI = 0.10-2.05). The incidence of quinsy was also reduced in relation to placebo group (OR = 0.18; 95% CI = 0.08-0.43). 3. Symptoms Symptoms of headache, throat soreness and fever were reduced by antibiotics to about one half. The greatest time for this to be evident was at about three and a half days (when the symptoms of about 50% of untreated patients had settled). About 90% of treated and untreated patients were symptom-free by one week. 4. Subgroup analyses of symptom reduction Subgroup analysis by age; blind vs unblinded; us of antipyretics; or results of swabs for Streptococcus yielded no significant differences. REVIEWER'S CONCLUSIONS: Antibiotics confer relative benefits in the treatment of sore throat. However, the absolute benefits are modest. Protecting sore throat sufferers against suppurative and non-suppurative complications in modern Western society can only be achieved by treating many with antibiotics who will derive no benefit. Antibiotics shorten the duration of symptoms, but by a mean of only about half of one day at day 3 (the time of maximal effect), and by about eight hours overall.

Anti-Bacterial Agents↗

PubMed1985

Should routine throat cultures be done in hospital personnel complaining of a sore throat?

In a 750-bed community-teaching hospital with 3,200 employees, throat cultures were routinely done in hospital personnel complaining of a sore throat. During a 3-month period, 323 employees had throat cultures; only 20 (6.2%) of these throat cultures grew group A streptococcus. The prevalence of positive throat cultures was similarly low in employees (6.2%) and adult patients (7.3%). There was no evidence that employees either had higher prevalence of group A streptococcal pharyngitis or that they spread the infection to patients. It is concluded that routine throat cultures are not warranted in employees complaining of a sore throat, and that throat cultures should be done only selectively in hospital personnel with a high probability of group A streptococcal pharyngitis.

Adolescent↗

PubMed1989

Sore throat in family practice: comparison of blood agar throat culture with a rapid enzyme immunoassay test for diagnostic purposes.

The Ventrescreen (Ventrex) rapid enzyme immunoassay test for detecting group A streptococcal antigen directly from a throat swab was compared with conventional blood agar throat culture in the diagnosis of beta haemolytic streptococcal infection among 311 patients with a sore throat attending a large suburban Jerusalem primary care clinic. Using the throat culture as the 'gold standard' the Ventrescreen test had a sensitivity of 82%, a specificity of 50%, a positive predictive value of 49%, and a negative predictive value of 82% for beta haemolytic streptococcal infection. These results are not good enough for the test to be considered a reliable substitute for throat culture in such a setting. The negative predictive value, however, supports the use of a negative test result to identify those patients in whom antibiotic therapy could be withheld until the result of their throat culture became available. These conclusions are at variance with recommendations from other studies of similar tests in different population groups, and stress the need for the careful evaluation, especially in primary care clinics, of any such rapid test which claims to be able to replace throat culture in the detection of beta haemolytic streptococcal infection.

Enzyme-Linked Immunosorbent Assay↗

PubMed1997

The prevalence of beta-haemolytic streptococci in throat specimens from healthy children and adults. Implications for the clinical value of throat cultures.

OBJECTIVE: To examine the influence of age and season of the year on the carrier rate of beta-haemolytic streptococci (BHS) in healthy individuals and patients with throat pain. DESIGN: The prevalence of BHS in throat specimens from healthy individuals was compared with that from patients with throat pain of the same age in a defined geographical area, collected during the same mid-winter and late summer periods. RESULTS: The prevalence of BHS in healthy individuals was low before the age of 3 years (1.9-7.1%) and in adults > or = 16 years (2.4-3.7%) and highest in the age group 3-15 years (5.0-21.2%). The difference in prevalence of BHS between healthy individuals and patients with throat pain was small during the late summer season and large during the mid-winter season. CONCLUSION: Prevalence of BHS varies with age and season in healthy individuals and patients with throat pain. During the summer, it is much more difficult to interpret the result of a throat culture in individuals aged < 16 years.

Adolescent↗

PubMed2000

Relief of sore throat with the anti-inflammatory throat lozenge flurbiprofen 8.75 mg: a randomised, double-blind, placebo-controlled study of efficacy and safety.

In this double-blind study, 301 patients with subjective and objective signs of sore throat were randomly assigned to flurbiprofen 8.75 mg (n = 129), flurbiprofen 12.5 mg (n = 43) or placebo (demulcent lozenge without active drug [n = 129]). Efficacy was assessed by changes in subjective rating scales primarily after a single dose and also over a 4-day period. Flurbiprofen 8.75 mg was superior to placebo in a number of efficacy parameters, notably throat soreness. Throat soreness was significantly reduced after 15 minutes (p < 0.05), with effects sustained for at least 2 hours (p < 0.05). Multiple dosing with flurbiprofen 8.75 mg lozenges continued to provide effective symptomatic relief over the 4-day treatment period. The small sample size was considered contributory to the variable results obtained with flurbiprofen 12.5 mg lozenges, but overall these were not inconsistent with previous trials. Both treatments were tolerated well. Flurbiprofen 8.75 mg lozenges provide an effective and well tolerated treatment for sore throat.

Adolescent↗

PubMed1978

The throat musculature of Sphenodon, with comments on the primitive character states of the throat muscles in lizards.

The throat musculature of Sphenodon is described and figured, and compared with that of lizards. In many features of its throat musculature, Sphenodon may well represent a primitive lepidosaurian pattern, comparable to some extent to the chelonian structure of throat musculature. To infer primitive character states within extant lizards, one cannot simply extrapolate from the condition observed in Sphenodon. In fact, it must be assumed that a rapid change of many features of the throat muscles occurred during the early evolution of lizards in order to provide the basis for further differentiation with extant lacertilian infraorders.

Animals↗

PubMed1993

The incidence of Streptococcus pyogenes in throat and plaque cultures in cases with acute throat infections.

This study was performed on 50 children with clinically suspected streptococcal upper respiratory tract infection at Abu-El-Rich hospital. DMF and plaque indices were recorded for all cases. Plaque and throat swabs were taken from all patients and directly inoculated on sheep blood agar plates. Haemolytic streptococci were further identified presumptively using bacitracin. 34% of cases had Beta-haemolytic streptococci type A (streptococcus pyogenes) in throat and 8% of cases had the same bacteria in plaque as well. This emphasizes the importance of proper plaque control in children together with the prophylactic ten days of antibiotic treatment in cases with acute throat infection to avoid the development of rheumatic heart disease in children.

Acute Disease↗

PubMed1986

A comparison between a commercial coagglutination test and conventional throat culture for the detection of group A streptococci in throat swabs.

A co-agglutination test (Phadirect Strep A) for rapid detection of group A streptococci in throat swabs was compared with conventional throat culture in 264 patients with pharyngotonsillitis and fever. The test was easy to perform and proved to have a satisfactory sensitivity and specificity. The predictive value of a positive test will be high also when the prevalence of streptococcal disease is low.

Agglutination Tests↗

PubMed1994

[Diagnosis of sore throat. A multipractice study of 3 different ways of antigenic determination for detection of group A streptococci in throat swabs].

During five months in the winter of 1992/1993, 34 general practitioners (GPs) from 18 offices participated in a clinical testing of three group A streptococcal antigen detection test (ADT) kits (Abbott TestPack Strep A Plus (Abbott), Concise Strep A, Hybritech (Concise) and Kodak SureCell Strep A (Kodak)). The GPs obtained duplicate throat swabs, one for processing with the ADT kit, the other for culture reference at The Streptococcus Laboratory (Bacteriological Department, Statens Seruminstitut, Copenhagen). A total of 1389 patients were enrolled in the study, thirty percent of whom were infected by group A streptococci. The following results were obtained: Abbott: Sensitivity: 76%, specificity: 99%, positive predictive value: 97%, negative predictive value: 91%. Concise: Sensitivity: 82%, specificity: 95%, positive predictive value: 86%, negative predictive value: 92%. Kodak: Sensitivity: 84%, specificity: 87%, positive predictive value: 73%, negative predictive value: 93%. As a follow-up to the main study, each GP filled in a questionnaire, stating his opinion about the investigated ADT kit. Considering the practical handiness, Concise scored higher than Abbott, which in turn scored higher than Kodak. In conclusion, Abbott and Concise are recommended for the diagnosis of group A streptococcal pharyngotonsillitis in general practice.

Antigens, Bacterial↗

PubMed1960