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Abstract：
OBJECTIVE: Group A Streptococcus (GAS) pharyngitis is currently the only commonly occurring form of acute pharyngitis for which antibiotic therapy is definitely indicated. Polish guidelines advocate the use of modified Centor score (MCS) to assess the probability of GAS pharyngitis. They advise performing throat culture or rapid antigen detection test (RADT) in children with score 2-3 in MCS and treating with antibiotic only those in whom GAS was detected. Negative RADT results should be confirmed by culture. In children with score 4, the guidelines allow to introduce empiric antibiotic therapy. Phenoxymethyl penicillin is recommended as a drug of choice to treat GAS pharyngitis. The aim of our study was to evaluate the accuracy of strategy recommended by Polish guidelines in identifying those children with acute pharyngitis who require antibiotic treatment. Hence, diagnostic values of score 4 in MCS and RADT were assessed using throat culture as a reference standard. Phenoxymethyl penicillin efficacy in GAS eradication and prevention of post-streptococcal complications were estimated as well.
METHODS: Ninety children between 2 and 15 years of age with acute pharyngitis symptoms suggesting GAS etiology (MCS ≥ 2), participated in our study. At the initial visit MCS was evaluated and two throat swabs were collected to perform RADT and culture. In children with GAS pharyngitis treated with penicillin, microbiological cure was assessed by performing two control throat cultures. Next, children were under observation for 3 months.
RESULTS: Positive predictive value of score 4 in MCS turned out to be 48.05% (95% CI: 36.5-59.7%). RADT sensitivity, specificity and diagnostic accuracy proved to be 100%, 96%, and 98%, respectively. GAS eradication rate in children treated with penicillin turned out to be 92.5%. No post-streptococcal sequelae occurred in any child in 3-month observation.
CONCLUSIONS: Empiric antibiotic therapy in children with score 4 in MCS will result in significant overtreatment of those with nonstreptococcal pharyngitis. New generation RADT diagnostic value in GAS detection proved to be equivalent to that of culture, which obviates the need of backup culture in children with negative RADT results. Phenoxymethyl penicillin revealed high eradication efficacy and proved to prevent post-streptococcal sequelae in children with acute GAS pharyngitis.
METHODS: Ninety children between 2 and 15 years of age with acute pharyngitis symptoms suggesting GAS etiology (MCS ≥ 2), participated in our study. At the initial visit MCS was evaluated and two throat swabs were collected to perform RADT and culture. In children with GAS pharyngitis treated with penicillin, microbiological cure was assessed by performing two control throat cultures. Next, children were under observation for 3 months.
RESULTS: Positive predictive value of score 4 in MCS turned out to be 48.05% (95% CI: 36.5-59.7%). RADT sensitivity, specificity and diagnostic accuracy proved to be 100%, 96%, and 98%, respectively. GAS eradication rate in children treated with penicillin turned out to be 92.5%. No post-streptococcal sequelae occurred in any child in 3-month observation.
CONCLUSIONS: Empiric antibiotic therapy in children with score 4 in MCS will result in significant overtreatment of those with nonstreptococcal pharyngitis. New generation RADT diagnostic value in GAS detection proved to be equivalent to that of culture, which obviates the need of backup culture in children with negative RADT results. Phenoxymethyl penicillin revealed high eradication efficacy and proved to prevent post-streptococcal sequelae in children with acute GAS pharyngitis.
摘要：
目的：A组链球菌（GAS）咽炎是目前唯一明确使用抗生素治疗的急性咽炎的常见形式。波兰指南提倡使用改良的Centor评分（MCS）来评估GAS咽炎的可能性。他们建议在MCS评分为2-3的儿童中进行喉咙培养或快速抗原检测测试（RADT），并且仅在检测到GAS的儿童中使用抗生素进行治疗。RADT阴性结果应通过培养证实。在评分为4的儿童中，指南允许引入经验性抗生素治疗。建议将苯氧甲基青霉素作为治疗GAS咽炎的首选药物。我们研究的目的是评估波兰指南推荐的策略在识别需要抗生素治疗的急性咽炎儿童中的准确性。因此，使用咽喉培养作为参考标准,评估MCS和RADT评分4的诊断价值.还估计了苯氧甲基青霉素在根除GAS和预防链球菌后并发症中的疗效。
方法：90名年龄在2至15岁之间的急性咽炎症状提示GAS病因（MCS≥2）的儿童，参与了我们的研究。在初次就诊时,评估MCS并收集两个咽拭子以进行RADT和培养。在用青霉素治疗的GAS咽炎儿童中，通过进行两次控制咽喉培养来评估微生物治愈。接下来,儿童接受了3个月的观察。
结果：MCS评分4的阳性预测值为48.05％（95％CI：36.5-59.7％）。RADT灵敏度,特异性和诊断准确性被证明是100%，96%,98%,分别。使用青霉素治疗的儿童的GAS根除率为92.5％。在3个月的观察中，任何儿童均未出现链球菌后后遗症。
结论：在MCS评分为4的儿童中，经验性抗生素治疗会导致非链球菌性咽炎患者明显过度治疗。新一代RADT在GAS检测中的诊断价值被证明与培养相当，这消除了对RADT结果阴性的儿童进行备份培养的需要。苯氧甲基青霉素显示出很高的根除效果，并被证明可以预防急性GAS咽炎儿童的链球菌后遗症。
方法：90名年龄在2至15岁之间的急性咽炎症状提示GAS病因（MCS≥2）的儿童，参与了我们的研究。在初次就诊时,评估MCS并收集两个咽拭子以进行RADT和培养。在用青霉素治疗的GAS咽炎儿童中，通过进行两次控制咽喉培养来评估微生物治愈。接下来,儿童接受了3个月的观察。
结果：MCS评分4的阳性预测值为48.05％（95％CI：36.5-59.7％）。RADT灵敏度,特异性和诊断准确性被证明是100%，96%,98%,分别。使用青霉素治疗的儿童的GAS根除率为92.5％。在3个月的观察中，任何儿童均未出现链球菌后后遗症。
结论：在MCS评分为4的儿童中，经验性抗生素治疗会导致非链球菌性咽炎患者明显过度治疗。新一代RADT在GAS检测中的诊断价值被证明与培养相当，这消除了对RADT结果阴性的儿童进行备份培养的需要。苯氧甲基青霉素显示出很高的根除效果，并被证明可以预防急性GAS咽炎儿童的链球菌后遗症。
