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Órgano Oficial de la Sociedad
Latinoamericana de lnfectología Pediátrica.
Órgano de la Asociación Mexicana de
Infectología Pediátrica, A.C.
Órgano difusor de la Sociedad Española
de lnfectología

2021, Number 2

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Rev Latin Infect Pediatr 2021; 34 (2)

Excerpt from the consensus document on the diagnosis and treatment of acute pharyngotonsillitis

Piñeiro PR, Hijano BF, Álvez GF, Fernández LA, Silva RJC, Pérez CC, Calvo RC, Cilleruelo OMJ, Grupo SEIP

Language: Spanish
References: 79
Page: 62-72
PDF size: 279.03 Kb.


ABSTRACT

Acute pharyngotonsillitis is one of the most common childhood illnesses. The most common aetiology is viral. Among the bacterial causes, the main agent responsible is Streptococcus pyogenes or beta haemolytic group A streptococcus. Clinical rating scales are a good aid in selecting children for rapid streptococcal antigen detection (RSAD) and/or culture of pharyngotonsillary samples. Without their use, there is a tendency to overdiagnose streptococcal acute pharyngotonsillitis, leading to unnecessary prescription of antibiotics, often broad-spectrum. The aims of treatment are: to accelerate the resolution of symptoms, to reduce the time of infection and to prevent local suppurative and non-suppurative complications. Ideally, only confirmed cases should be treated. In case of unavailability of RSAD, or in some cases, in case of a negative result, it is recommended to obtain culture and initiate treatment pending results, only if clinical suspicion is high. The antibiotics of choice for the treatment of streptococcal AFA are penicillin and amoxicillin. Amoxicillin-clavulanic acid is not indicated empirically in acute infection. Macrolides are also not a first-choice treatment; their use should be reserved for patients with immediate penicillin allergy or as eradicant treatment, when indicated. It is urgent and a priority in our country to adapt antibiotic prescribing to the available scientific evidence.


REFERENCES

  1. Álvez González F, Sánchez Lastres JM. Faringoamigdalitis aguda. Protocolos de Infectología de la Asociación Española de Pediatría. [Consultado 1/7/11]. Disponible en: http://www.aeped.es/documentos/protocolos-infectologia

  2. Wessels MR. Clinical practice. Streptococcal pharyngitis. N Engl J Med. 2011; 364: 648-655.

  3. Álvez González F. Faringitis estreptocócica en niños menores de 2 años. An Pediatr (Barc). 2008; 68: 525-539.

  4. Matas L, Méndez M, Rodrigo C, Ausina V. Diagnóstico de las faringitis estreptocócicas. Enferm Infecc Microbiol Clin. 2008; 26: 14-18.

  5. Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics. 2010; 126: e557-e564.

  6. Flores Mateo G, Conejero J, Grenzner Martinel E, Baba Z, Dicono S, Echasabal M et al. Early diagnosis of streptococcal pharyngitis in paediatric practice: validity of a rapid antigen detection test. Aten Primaria. 2010; 42: 356-361.

  7. Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever. Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2009; 119: 1541-1551.

  8. Domínguez O, Rojo P, De las Heras S, Folgueira D, Ruíz Contreras J. Clinical presentation characteristics of pharyngeal adenovirus infections. Pediatr Infect Dis J. 2005; 24: 733-734.

  9. Carbonero Celis MJ, Torronteras Santiago R, Cintado Bueno C. Mononucleosis infecciosa: estudio en niños hospitalizados. An Esp Pediatr. 1999; 51: 664-666.

  10. Hervás Ángulo A, Arizcuren Domeño MA, Tiberio López G, Oteiza Olaso J. Características clínico-analíticas y complicaciones de pacientes con mononucleosis infecciosa derivados desde atención primaria a atención especializada. Aten Primaria. 2003; 32: 311.

  11. Santiago Sánchez Mateos JL, Aboín González S, García Millán C, Jaén Olasolo P. Mononucleosis infecciosa. Med Clin (Barc). 2008; 130: 520.

  12. Bisno AL. Acute pharyngitis. N Engl J Med. 2001; 344: 205-211.

  13. Cooper RJ, Hoffman JR, Barlett JG, Besser RE, Gonzales R, Hickner JM et al. Principles of appropriate antibiotic use for acute pharyngitis in adults: background. Ann Intern Med. 2001; 134: 509-517.

  14. Snow V, Mottur-Pilson C, Cooper RJ, Hoffman JR. Principles of appropriate antibiotic use for acute pharyngitis in adults. Ann Intern Med. 2001; 134: 506-508.

  15. Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strep throat in adults in the emergency room. Med Decis Making. 1981; 1: 239-246.

  16. McIsaac WJ, Kellner JD, Aufricht P, Vanjaka A, Low DE. Empirical validation of guidelines for the management of pharyngitis in children adults. JAMA. 2004; 291: 1587-1595 [Erratum, JAMA 2005; 294: 2700].

  17. Ruíz-Aragón J, Rodríguez López R, Molina Linde JM. Evaluación de los métodos rápidos para la detección de Streptococcus pyogenes. Revisión sistemática y metaanálisis. An Pediatr (Barc). 2010; 72: 391-402.

  18. Mayes T, Pichichero ME. Are follow-up throat cultures necessary when rapid antigen detection tests are negative for group A streptococci? Clin Pediatr (Phila). 2001; 40: 191-195.

  19. Cohen R, Levy C, Ovetchkine P, Boucherat M, Weil-Olivier C, Gaudelus J et al. Evaluation of streptococcal clinical scores, rapid antigen detection tests and cultures for childhood pharyngitis. Eur J Pediatr. 2004; 163: 281-282.

  20. Gerber MA, Shulman ST. Rapid diagnosis of pharyngitis caused by group A streptococci. Clin Microbiol Rev. 2004; 17: 571-580.

  21. Jaggi P, Shulman ST, Group A. Streptococcal infections. Pediatr Rev. 2006; 27: 99-105.

  22. Sarikaya S, Aktas C, Ay D, Cetin A, Celikmen F, Sensitivity. Specificity of rapid antigen detection testing for diagnosing pharyngitis in the emergency department. Ear Nose Throat J. 2010; 89: 180-182.

  23. Fernández-Cuesta Valcarce MA. Faringitis aguda. En: Hernández Merino A, Bravo Acuna J, Merino Moíña M, Ramos Amador JT, Rojo Conejo P, Ruiz Contreras J, editores. Guía ABE. Infecciones en pediatría. Madrid: Exlibris Ediciones SL, Asociación Española de Pediatría de Atención Primaria; 2010. pp. 153-158.

  24. Herranz B, Rodríguez-Salinas E, Orden B. Utilidad de las técnicas de diagnóstico rápido para la detección de Streptococcus pyogenes. An Pediatr Cont. 2007; 5: 92-95.

  25. Denny FW, Wannamaker LW, Brink WR, Rammelkamp Jr CH, Custer EA. Prevention of rheumatic fever; treatment of the preceding streptococcic infection. J Am Med Assoc. 1950; 143: 151-153.

  26. Catanzaro FJ, Stetson CA, Morris AJ, Chamovitz R, Rammelkamp Jr CH, Stolzer BL et al. The role of the streptococcus in the pathogenesis of rheumatic fever. Am J Med. 1954; 17: 749-756.

  27. Potter EV, Svartman M, Mohammed I, Cox R, Poon-King T, Earle DP. Tropical acute rheumatic fever and associated streptococcal infections compared with concurrent acute glomerulonephritis. J Pediatr. 1978; 92: 325-333.

  28. Randolph MF, Gerber MA, De Meo KK, Wright L. Effect of antibiotic therapy on the clinical course of streptococcal pharyngitis. J Pediatr. 1985; 106: 870-875.

  29. Krober MS, Bass JW, Michaels GN. Streptococcal pharyngitis: Placebo-controlled double blind evaluation of clinical response to penicillin therapy. JAMA. 1985; 253: 1271-1274.

  30. Pichichero ME, Disney FA, Talpey WB, Green JL, Francis AB, Roghmann KJ et al. Adverse beneficial effect of immediate treatment of group A -hemolytic streptococcal pharyngitis with penicillin. Pediatr Infect Dis J. 1987; 6: 635-643.

  31. Snellman LW, Stang HJ, Stang JM, Johnson DR, Kaplan EL. Duration of positive throat cultures for group A streptococci after initiation of antibiotic therapy. Pediatrics. 1993; 91: 1166-1170.

  32. Bisno AL, Gerber MA, Gwaltney JM, Kaplan EL, Schwartz RH. Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Clin Infect Dis. 2002; 35: 113-125.

  33. Robertson KA, Volmink JA, Mayosi EM. Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis. BMC Cardiovasc Disord. 2005; 5: 11.

  34. Pichichero M, Casey J. Comparison of European and U.S. results for cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis. Eur J Clin Microbiol Infect Dis. 2006; 25: 354-364.

  35. Del Mar CB, Glasziou PP, Spinks AB. Antibiotics for sore throat. Cochrane Database Syst Rev. 2006; 4: CD000023.

  36. Alcaide ML, Bisno AL. Pharyngitis epiglottitis. Infect Dis Clin N Am. 2007; 21: 449-469.

  37. Shulman ST, Tanz RR, Dale JB, Beall B, Kabat W, Kabat K et al. Seven-year surveillance of North American pediatric group A streptococcal pharyngitis isolates. Clin Infect Dis. 2009; 49: 78-84.

  38. Carapetis J, Steer A. Prevention of rheumatic fever. Pediatr Infect Dis J. 2010; 29: 91-92.

  39. Álvez F. Uso racional de antibióticos en las infecciones más comunes de los niños. An Pediatr Contin. 2010; 8: 221-230.

  40. Peñalba Citores AC, Riaño Méndez B, Marañón Pardillo R, Míguez Navarro C, Vázquez López P, Guerrero Soler MM et al. Incidencia de faringitis estreptocócica. An Pediatr (Barc). 2007; 67: 220-224.

  41. Álvez F, Martín C. Infecciones por estreptococo beta hemolítico grupo A (EBGHA) y sus complicaciones. Estado de portador y recurrencias. En: Gómez Campedrá JA, Jiménez Ferreros L, Álvarez Calatayud G, editores. Patología aguda ORL en pediatría. Madrid: GlaxoSmithKline; 2004. pp. 83-96.

  42. Coonan KM, Kaplan EL. In vitro susceptibility of recent North American group A streptococcal isolates to eleven oral antibiotics. Pediatr Infect Dis J. 1994; 13: 630-635.

  43. Horn DL, Zabriskie JB, Austrian R, Cleary PP, Ferretti JJ, Fischetti VA et al. Why have group A streptococci remained susceptible to penicillin: Report on a simposium. Clin Infect Dis. 1998; 26: 1341-1345.

  44. Van Driel ML, De Sutter AI, Keber N, Habraken H, Christiaens T. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database Syst Rev. 2010; 6: CD004406.

  45. Baltimore RS. Re-evaluation of antibiotic treatment of streptococcal pharyngitis. Curr Opin Pediatr. 2010; 22: 77-82.

  46. Curtin-Wirt C, Casey JR, Murray PC, Cleary CT, Hoeger WJ, Marsocci SM et al. Efficacy of penicillin vs amoxicillin in children with Group A beta hemolytic streptococcal tonsillopharyngitis. Clin Pediatr (Phila). 2003; 42: 219-225.

  47. Clegg HW, Ryan AG, Dallas SD, Kaplan EL, Johnson DR, Norton HJ et al. Treatment of streptococcal pharyngitis with once-daily compared with twice-daily amoxicillin: a noninferiority trial. Pediatr Infect Dis J. 2006; 25: 761-767.

  48. Lennon DR, Farrel E, Martin DR, Stewart JM. Once-daily amoxicillin versus twice daily penicillin V in group A beta-hemolytic streptococcal pharyngitis. Arch Dis Child. 2008; 93: 474-478.

  49. Ochoa Sangrador C, Vilela Fernández M, Cueto Baelo M, Eiros Bouza JM, Inglada Galiana L. Adecuación del tratamiento de la faringoamigdalitis aguda a la evidencia científica. An Pediatr (Barc). 2003; 59: 31-40.

  50. Casaní Martínez C, Calvo Rigual F, Peris Vidal A, Álvares de Lavida Mulero T, Díez Domingo J, Graullera Millas M et al. Encuesta sobre el uso racional de antibióticos en atención primaria. An Pediatr (Barc). 2003; 58: 10-16.

  51. Durán Fernández Feijoo C, Marqués Ercilla S, Hernández Bou S, Trenchs Sainz de la Maza V, García García JJ, Luaces Cubells C. Calidad de la prescripción antibiótica en un servicio de urgencias pediátrico hospitalario. An Pediatr (Barc). 2010; 73: 115-120.

  52. Albañil Ballesteros MR, Calvo Rey C, Sanz Cuesta T. Variación de la prescripción de antibióticos en atención primaria. An Esp Pediatr. 2002; 57: 420-426.

  53. Kaplan EL, Johnson DR. Eradication of group A streptococci from the upper respiratory tract by amoxicillin with clavulanate after oral penicillin V treatment failure. J Pediatr. 1988; 113: 400-403.

  54. Casey JR, Pichichero ME. Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children. Pediatrics. 2004; 113: 866-882.

  55. Kaplan EL, Oakes JM, Johnson DR. Unexpected individual clinical site variation in eradication rates of group a Streptococci by penicillin in multisite clinical trials. Pediatr Infect Dis J. 2007; 26: 1110-1116.

  56. Shulman ST, Gerber MA. So what's wrong with penicillin for strep throat? Pediatrics. 2004; 113: 1816-1819.

  57. Álvez F. Eficacia de la penicilina en el tratamiento de las faringoamigdalitis estreptocócicas. An Pediatr Contin. 2004; 2: 105-117.

  58. Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics. 2005; 115: 1048-1057.

  59. Perez-Trallero E, Urbieta M, Montes M, Ayestaran I, Marimon JM. Emergence of Streptococcus pyogenes strains resistant to erythromycin in Gipuzkoa, Spain. Eur J Clin Microbiol Infect Dis. 1998; 17: 25-31.

  60. Orden B, Perez-Trallero E, Montes M, Martínez R. Erythromycin resistance of Streptococcus pyogenes in Madrid. Pediatr Infect Dis J. 1998; 17: 470-473.

  61. Betriu C, Casado MC, Gómez M, Sanchez A, Palau ML, Picazo JJ. Incidence of erythromycin resistance in Streptococcus pyogenes: a 10-year study. Diagn Microbiol Infect Dis. 1999; 33: 255-260.

  62. Pérez-Trallero E, Martín-Herrero JE, Mazón A, García-Delafuente C, Robles P, Iriarte V et al. Antimicrobial resistance among respiratory pathogens in Spain: latest data and changes over 11 years (1996-1997 to 2006-2007). Antimicrob Agents Chemother. 2010; 54: 2953-2959.

  63. Casey JR, Pichichero ME. Higher dosages of azithromycin are more effective in treatment of group A streptococcal tonsillopharyngitis. Clin Infect Dis. 2005; 40: 1748-1755.

  64. Cohen R, Reinert P, De La Rocque F, Levy C, Boucherat M, Robert M et al. Comparison of two dosages of azithromycin for three days versus penicillin V for ten days in acute group A streptococcal tonsillopharyngitis. Pediatr Infect Dis J. 2002; 21: 297-303.

  65. Cohen R. Defining the optimum treatment regimen for azithromycin in acute tonsillopharyngitis. Pediatr Infect Dis J. 2004; 23: 129-134.

  66. Richter SS, Heilmann KP, Beekmann SE, Miller NJ, Miller Al, Rice CL et al. Macrolide-resistant Streptococcus pyogenes in the United States, 2002-2003. Clin Infect Dis. 2005; 41: 599-608.

  67. Tanz RR, Shulman ST, Shortridge VD, Kabat W, Kabat K, Cederlund E et al. Community-based surveillance in the United States of macrolide-resistant pediatric pharyngeal group A streptococci during 3 respiratory disease seasons. Clin Infect Dis. 2004; 39: 1794-1801.

  68. Kim S, Yong Lee N. Antibiotics resistance and genotypic characteristics of group A streptococci associated with acute pharyngitis in Korea. Microb Drug Resist. 2004; 10: 300-305.

  69. Tamayo J, Pérez-Trallero E, Gómez-Garcés JL, Alós JI. Resistance to macrolides, clindamycin and telithromycin in Streptococcus pyogenes isolated in Spain during 2004. J Antimicrob Chemoter. 2005; 56: 780-782.

  70. Rodríguez D, Danés I. Nuevas pautas de antibioterapia en la faringoamigdalitis aguda. Med Clin (Barc). 2001; 117: 115-116.

  71. Falagas ME, Vouloumanou EK, Matthaiou DK, Kapaskelis AM, Karageorgopoulos DE. Effectiveness and safety of short-course vs long-course antibiotic therapy for group a beta hemolytic streptococcal tonsillopharyngitis: a meta-analysis of randomized trials. Mayo Clin Proc. 2008; 83: 880-889.

  72. Markowitz M, Gerber MA, Kaplan EL. Treatment of streptococcal pharyngotonsillitis: reports of penicillin's demise are premature. J Pediatr. 1993; 123: 679-685.

  73. Kaplan EL. The group A streptococcal upper respiratory tract carrier state: an enigma. J Pediatr. 1980; 97: 337-345.

  74. Schwartz RH, Wientzen RL Jr, Pedreira F, Feroli EJ, Mella GW, Guandolo VL. Penicillin V for group A streptococcal pharyngotonsillitis. A randomized trial of seven vs ten days' therapy. JAMA. 1981; 246: 1790-1795.

  75. Gerber MA. Treatment failures and carriers: perception or problems? Pediatr Infect Dis J. 1994; 13: 576-579.

  76. Kaplan EL, Chhatwal GS, Rohde M. Reduced ability of penicillin to eradicate ingested group A streptococci from epithelial cells: clinical and pathogenic implications. Clin Infect Dis. 2006; 43: 1398-1406.

  77. Marshall GS, Edwards KM, Butler J, Lawton AR. Syndrome of periodic fever, pharyngitis, and aphthous stomatitis. J Pediatr. 1987; 110: 43-46.

  78. Feder HM, Salazar JC. A clinical review of 105 patients with PFAPA (a periodic fever syndrome). Acta Paediatr. 2010; 99: 178-184.

  79. Calvo Rey C, Soler-Palacín P, Muñoz RM, Lozano JS, López JA, Aróstegui JI et al. Documento de Consenso de la Sociedad de Infectología Pediátrica y la Sociedad de Reumatología Pediátrica sobre el diagnóstico diferencial y el abordaje terapéutico de la fiebre recurrente. An Pediatr (Barc). 2011; 74: e1-16.




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