Management of Acute Pharyngitis in Children: Summary of the Italian National Institute of Health Guidelines

Clinical Therapeutics

Volumn 34, Issue 6, 2012, Pages

  Chiappini, Elena ^a,b   Principi, Nicola ^c   Mansi, Nicola ^d   Serra, Agostino ^e   De Masi, Salvatore ^b   Camaioni, Angelo ^f   Esposito, Susanna ^c   Felisati, Giovanni ^c   Galli, Luisa ^a,b   Landi, Massimo ^g   Speciale, Anna Maria ^e   Bonsignori, Francesca ^a   Marchisio, Paola ^c   de Martino, Maurizio ^a,b  

^a UNIVERSITY OF FLORENCE   (Italy)

^b UNIVERSITY OF FLORENCE   (Italy)

^c UNIVERSITY OF MILAN   (Italy)

^d SANTOBONO PAUSILIPON CHILDREN S HOSPITAL   (Italy)

^e UNIVERSITY OF CATANIA   (Italy)

^f MOLINETTE HOSPITAL   (Italy)

^g National Pediatric Primary Care System   (Italy)

Author keywords

[No Author keywords available]

Indexed keywords

AMOXICILLIN; AZITHROMYCIN; BENZATHINE PENICILLIN; CEFACLOR; CEFPROZIL; CEFTRIAXONE; CEFUROXIME; CEFUROXIME AXETIL; CEPHALOSPORIN; CLINDAMYCIN; IBUPROFEN; MACROLIDE; PARACETAMOL; PENICILLIN G; PENICILLIN V; RIFAMPICIN; SULTAMICILLIN;

ANALGESIA; ANTIBIOTIC SENSITIVITY; ANTIBIOTIC THERAPY; ARTICLE; BACTERIUM CULTURE; BETA HEMOLYTIC STREPTOCOCCUS; DIAGNOSTIC TEST; DISEASE TRANSMISSION; FEVER; HUMAN; LOW DRUG DOSE; PAIN; PRACTICE GUIDELINE; RHEUMATIC DISEASE; SCORING SYSTEM; STAPHYLOCOCCUS; STREPTOCOCCAL PHARYNGITIS; SYSTEMATIC REVIEW; VIRUS INFECTION;

EID: 84956571761     PISSN: 01492918     EISSN: 1879114X     Source Type: Journal    
DOI: 10.1016/j.clinthera.2012.04.028     Document Type: Article

References (104)

1. Red Book: Report of the Committee on Infectious Diseases 2009, American Academy of Pediatrics, Committee on Infectious Diseases, American Academy of Pediatrics, Elk Grove Village, IL. 28th ed.
2. Choby B.A. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician 2009, 79:383-390.
3. Ebell M.H., Smith M.A., Barry H.C., et al. The rational clinical examination. Does this patient have strep throat?. JAMA 2000, 284:2912-2918.
4. Gerber M.A., Baltimore R.S., Eaton C.B., et al. Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis: a scientific statement from the American Heart Association endorsed by the American Academy of Pediatrics. Circulation 2009, 119:1541-1551.
5. Chiappini E., Regoli M., Bonsignori F., et al. Analysis of different recommendations from international guidelines for the management of acute pharyngitis in adults and children. Clin Ther 2011, 33:48-58.
6. Shaikh N., Leonard E., Martin J.M. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics 2010, 126:e557-e564.
7. Methodological handbook-how to produce, disseminate and update clinical practice recommendations Il Programma Nazionale per le Linee Guida (PNLG), Accessed December 30, 2011. http://www.pnlg.it/en_method.
8. Management of sore throat Scottish Intercollegiate Guidelines Network, Accessed December 30, 2011. http://www.sign.ac.uk.
9. Hayden G.F., Turner R.B. Acute pharyngitis. Nelson Textbook of Pediatrics 2007, 378:1752-1754. Saunders, Philadelphia, Pa. 18th ed.
10. Lin M.H., Fong W.K., Chang P.F., et al. Predictive value of clinical features in differentiating group A beta-hemolytic streptococcal pharyngitis in children. J Microbiol Immunol Infect 2003, 36:21-25.
11. Gerber M.A., Shulman S.T. Rapid diagnosis of pharyngitis caused by group A streptococci. Clin Microbiol Rev 2004, 17:571-580.
12. Shaikh N., Swaminathan N., Hooper E.G. Accuracy and precision of the signs and symptoms of streptococcal pharyngitis in children: a systematic review. J Pediatr 2012, 160:487-493.e3.
13. Aalbers J., O'Brien K.K., Chan W.S., et al. Predicting streptococcal pharyngitis in adults in primary care: a systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score. BMC Med 2011, 9:67.
14. Hossain P., Kostiala A., Lyytikainen O., Kurki S. Clinical features of district hospital paediatric patients with pharyngeal group A streptococci. Scand J Infect Dis 2003, 35:77-79.
15. Breese B.B. A simple scorecard for the tentative diagnosis of streptococcal pharyngitis. Am J Dis Child 1977, 131:514-517.
16. Karacan M., Karakelleoglu C., Orbak Z. Diagnosis of group A beta-hemolytic Streptococcus using the Breese clinical scoring system. Southern Med J 2007, 100:1192-1197.
17. Centor R.M., Witherspoon J.M., Dalton H.P., et al. The diagnosis of strep throat in adults in the emergency room. Med Decis Making 1981, 1:239-246.
18. Tanz R.R., Gerber M.A., Kabat W., et al. Performance of a rapid antigen-detection test and throat culture in community pediatric offices: implications for management of pharyngitis. Pediatrics 2009, 123:437-444.
19. McIsaac W.J., Kellner J.D., Aufricht P., et al. Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA 2004, 291:1587-1595.
20. McIsaac W.J., Goel V., To T., et al. Effect of antibiotic prescribing of repeated clinical prompts to use a sore throat score. J Fam Practice 2002, 5:339-344.
21. Attia M.W., Zaoutis T., Lein J.D., Meier F.A. Performance of a predictive model for streptococcal pharyngitis in children. Arch Pediatr Adolesc Med 2001, 155:687-691.
22. Fontes M.J., Bottrel F.B., Fonseca M.T., et al. Early diagnosis of streptococcal pharyngotonsillitis: assessment by latex particle agglutination test. J Pediatr 2007, 83:465-470.
23. Fox J.W., Cohen D.M., Marcon M.J., et al. Performance of rapid streptococcal antigen testing varies by personnel. J Clin Microbiol 2006, 44:3918-3922.
24. van der Veen E.L., Sanders E.A., Videler W.J., et al. Optimal site for throat culture: tonsillar surface versus posterior pharyngeal wall. Eur Arch Otorhinolaryngol 2006, 263:750-753.
25. Ezike E.N., Rongkavilit C., Fairfax M.R., et al. Effect of using 2 throat swabs vs 1 throat swab on detection of group A streptococcus by a rapid antigen detection test. Arch Pediatr Adolesc Med 2005, 159:486-490.
26. Gurol Y., Akan H., Izbirak G., et al. The sensitivity and the specificity of rapid antigen test in streptococcal upper respiratory tract infections. Int J Pediatr Otorhinolaryngol 2010, 74:591-593.
27. Saxena A., Kumar R.K., Gera R.P., et al. Consensus guidelines on pediatric acute rheumatic fever and rheumatic heart disease. Indian Pediatr 2008, 45:565-573.
28. Van Howe R.S., Kusnier L.P. Diagnosis and management of pharyngitis in a pediatric population based on cost-effectiveness and projected health outcomes. Pediatrics 2006, 11:609-619.
29. Maltezou H.C., Tsagris V., Antoniadou A., et al. Evaluation of a rapid antigen detection test in the diagnosis of streptococcal pharyngitis in children and its impact on antibiotic prescription. J Antimicrob Chemother 2008, 62:1407-1412.
30. Hall M.C., Kieke B., Gonzales R., Belongia E.A. Spectrum bias of a rapid antigen detection test for group A beta-hemolytic streptococcal pharyngitis in a pediatric population. Pediatrics 2004, 114:182-186.
31. Johansson L., Månsson N.O. Rapid test, throat culture and clinical assessment in the diagnosis of tonsillitis. Fam Pract 2003, 20:108-111.
32. Edmonson M.B., Farwell K.R. Relationship between the clinical likelihood of group a streptococcal pharyngitis and the sensitivity of a rapid antigen-detection test in a pediatric practice. Pediatrics 2005, 115:280-285.
33. Gurol Y., Akan H., Izbirak G., et al. The sensitivity and the specificity of rapid antigen test in streptococcal upper respiratory tract infections. Int J Pediatr Otorhinolaryngol 2010, 74:591-593.
34. Goldfarb D.M., Slinger R., Tam R.K., et al. Assessment of flocked swabs for use in identification of streptococcal pharyngitis. J Clin Microbiol 2009, 47:3029-3030.
35. Bisno A.L., Stevens D.L. Streptococcus pyogenes. Principles and Practice of Infectious Diseases 2004, Churchill Livingston, Philadelphia, PA, part III. 6th ed. G.L. Mandell, J.E. Bennett, R. Dolin (Eds.).
36. Ruoff K.L., Whiley R.A., Beighton D. Streptococcus. Manual of Clinical Microbiology 2007, ASM Press, Washington, DC. 9th ed. P.R. Murray, E.J. Baron, J. Jorgensen (Eds.).
37. Martin J.M., Green M., Barbadora K.A., Wald E.R. Group A streptococci among school-aged children: clinical characteristics and the carrier state. Pediatrics 2004, 114:1212-1219.
38. Bisno A.L., Gerber M.A., Gwaltney J.M., et al. Infectious Diseases Society of America: practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Clin Infect Dis 2002, 35:113-125.
39. Fox J.W., Marcon M.J., Bonsu B.K. Diagnosis of streptococcal pharyngitis by detection of Streptococcus pyogenes in posterior pharyngeal versus oral cavity specimens. J Clin Microbiol 2006, 44:2593-2594.
40. Gieseker K.E., Mackenzie T., Roe M.H., Todd J.K. Comparison of two rapid Streptococcus pyogenes diagnostic tests with a rigorous culture standard. Pediatr Infect Dis J 2002, 21:922-927.
41. Nerbrand C., Jasir A., Schalén C. Are current rapid detection tests for group A streptococci sensitive enough?. Evaluation of 2 commercial kits. Scand J Infect Dis 2002, 34:797-799.
42. Van Limbergen J., Kalima P., Taheri S., Beattie T.F. Streptococcus A in paediatric accident and emergency: are rapid streptococcal tests and clinical examination of any help?. Emerg Med J 2006, 23:32-34.
43. Armengol C.E., Schlager T.A., Hendley J.O. Sensitivity of a rapid antigen detection test for group A streptococci in a private pediatric office setting: answering the Red Book's request for validation. Pediatrics 2004, 113:924-926.
44. Mirza A., Wludyka P., Chiu T.T., Rathore M.H. Throat culture is necessary after negative rapid antigen detection tests. Clin Pediatr 2007, 46:241-246.
45. Al-Najjar F.Y., Uduman S.A. Clinical utility of a new rapid test for the detection of group A Streptococcus and discriminate use of antibiotics for bacterial pharyngitis in an outpatient setting. Int J Infect Dis 2008, 12:308-311.
46. Santos O., Weckx L.L., Pignatari A.C., Pignatari S.S. Detection of Group A beta-hemolytic Streptococcus employing three different detection methods: culture, rapid antigen detecting test, and molecular assay. Braz J Infect Dis 2003, 7:297-300.
47. Cohen R., Levy C., Ovetchkine P., et al. Evaluation of streptococcal clinical scores, rapid antigen detection tests and cultures for childhood pharyngitis. Eur J Pediatr 2004, 163:281-282.
48. Camurdan A.D., Camurdan O.M., Ok I., et al. Diagnostic value of rapid antigen detection test for streptococcal pharyngitis in a pediatric population. Int J Pediatr Otorhinolaryngol 2008, 72:1203-1206.
49. Gieseker K.E., Roe M.H., MacKenzie T., Todd J.K. Evaluating the American Academy of Pediatrics diagnostic standard for Streptococcus pyogenes pharyngitis: backup culture versus repeat rapid antigen testing. Pediatrics 2003, 111:666-670.
50. Avanruoh S., Waseem M., Quee F., Humphrey A., Reynolds T. Impact of rapid streptococcal test on antibiotic use in a pediatric emergency department. Pediatr Emerg Care 2009, 25:748-750.
51. Brook I., Gober A.E. Increased recovery of Moraxella catarrhalis and Haemophilus influenzae in association with group A beta-haemolytic streptococci in healthy children and those with pharyngo-tonsillitis. J Med Microbiol 2006, 55:989-992.
52. Lindbaek M., Høiby E.A., Lermark G., et al. Clinical symptoms and signs in sore throat patients with large colony variant beta-haemolytic streptococci groups C or G versus group A. Br J Gen Pract 2005, 55:615-619.
53. Fretzayas A., Moustaki M., Kitsiou S., et al. The clinical pattern of group C streptococcal pharyngitis in children. J Infect Chemother 2009, 15:228-232.
54. Batty A., Wren M.W., Gal M. Fusobacterium necrophorum as the cause of recurrent sore throat: comparison of isolates from persistent sore throat syndrome and Lemierre's disease. J Infect 2005, 51:299-306.
55. Abu-Saraah A.H., Ghazi H.Q. Better diagnosis and treatment of throat infections caused by group A β-hemolytic streptococci. Br J Biomed Sci 2006, 63:155-158.
56. Robertson K.A., Volmink J.A., Mayosi B.M. Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis. BMC Cardiovasc Disord 2005, 31:11. 5.
57. Lennon D., Kerdemelidis M., Arroll B. Meta-analysis of trials of streptococcal throat treatment programs to prevent rheumatic fever. Pediatr Infect Dis J 2009, 28:e259-e264.
58. Del Mar C.B., Glasziou P.P., Spinks A.B. Antibiotics for sore throat. Cochrane Database Syst Rev 2006, (4). CD000023.
59. Arroll B. Antibiotics for upper respiratory tract infections: an overview of Cochrane reviews. Respir Med 2005, 99:255-261.
60. Spurling G.K., Del Mar C.B., Dooley L., Foxlee R. Delayed antibiotics for symptoms and complications of respiratory infections. Cochrane Database Syst Rev 2004, 4. CD004417.
61. Little P. Delayed prescribing of antibiotics for upper respiratory tract infection. Br Med J 2005, 331:301-302.
62. Barash J. Group A streptococcal throat infection-to treat or not to treat. Acta Paediatr 2009, 98:434-436.
63. Arnold S.R., Straus S.E. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev 2005, 4. CD003539.
64. Van Driel M.L., De sutter A.I., Keber N., et al. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database Syst Rev 2010, 10. CD004406.
65. Shvartzman P. Treatment of streptococcal pharyngitis with amoxycillin once a day. Br Med J 1993, 306:170-172.
66. Feder H.M. Once-daily therapy for streptococcal pharyngitis with amoxicillin. Pediatrics 1999, 103:47-51.
67. Lennon D.R., Farrell E., Martin D.R., Stewart J.M. Once-daily amoxicillin versus twice-daily penicillin V in group A beta-haemolytic streptococcal pharyngitis. Arch Dis Child 2008, 93:474-478.
68. Clegg H.W., Ryan A.G., Dallas S.D., 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.
69. Altamimi S., Khalil A., Khalaiwi K.A., et al. Short versus standard duration antibiotic therapy for acute streptococcal pharyngitis in children. Cochrane Database Syst Rev 2009, 1. CD004872.
70. Pichichero M.E., Casey J.R., Block S.L., et al. Pharmacodynamic analysis and clinical trial of amoxicillin sprinkle administered once daily for 7 days compared to penicillin V potassium administered four times daily for 10 days in the treatment of tonsillopharyngitis due to Streptococcus pyogenes in children. Antimicrob Agents Chemother 2008, 52:2512-2520.
71. Falagas M.E., Vouloumanou E.K., Matthaiou D.K., et al. 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. Casey J.R., Kahn R., Gmoser D., et al. Frequency of symptomatic relapses of group A beta-hemolytic streptococcal tonsillopharyngitis in children from 4 pediatric practices following penicillin, amoxicillin, and cephalosporin antibiotic treatment. Clin Pediatr (Phila) 2008, 47:549-554.
73. Casey J.R., Pichichero M.E. The evidence base for cephalosporin superiority over penicillin in streptococcal pharyngitis. Diagn Microbiol Infect Dis 2007, 57:39-45.
74. Cohen R. Defining the optimum treatment regimen for azithromycin in acute tonsillopharyngitis. Pediatr Infect Dis J 2004, 23:S129-S134.
75. Razon Y., Ashkenazi S., Cohen A., et al. Effect of educational intervention on antibiotic prescription practices for upper respiratory infections in children: a multicentre study. J Antimicrob Chemother 2005, 56:937-940.
76. Esposito S., Bosis S., Begliatti E., et al. Acute tonsillopharyngitis associated with atypical bacterial infection in children: natural history and impact of macrolide therapy. Clin Infect Dis 2006, 43:206-209.
77. Esposito S., Cavagna R., Bosis S., et al. Emerging role of Mycoplasma pneumoniae in children with acute pharyngitis. Eur J Clin Microbiol Infect Dis 2002, 21:607-610.
78. Pierce C.A., Voss B. Efficacy and safety of ibuprofen and acetaminophen in children and adults. A meta-analysis and qualitative review. Ann Pharmacother 2010, 44:489-506.
79. Chiappini E., Principi N., Longhi R., et al. Management of fever in children: summary of the Italian Pediatric Society Guidelines. Clin Ther 2009, 31:1826-1843.
80. Jasimuddin A., Zaman M., Keramat S.M. Immunological response to antioxidant vitamin supplementation in rural Bangladeshi school children with group A streptococcal infection. Asia Pac J Clin Nutr 2004, 13:226-230.
81. Varricchio A., Capasso M., Di Gioacchino M., Ciprandi G. Inhaled thiamphenicol and acetilcysteine in children with acute bacterial rhinopharyngitis. Int J Immunopathol Pharmacol 2008, 21:625-629.
82. Tanz R.R., Shulman S.T. Chronic pharyngeal carriage of group A streptococci. Pediatr Infect Dis J 2007, 26:175.
83. Cockerill F.R., MacDonald K.L., Thompson R.L., et al. An outbreak of invasive group A streptococcal disease associated with high carriage rates of the invasive clone among school-aged children. JAMA 1997, 277:38-43.
84. Tanz R.R., Shulman S.T., Barthel M.J., et al. Penicillin plus rifampin eradicates pharyngeal carriage of group A streptococci. J Pediatr 1985, 106:876-880.
85. Tanz R.R., Poncher J.R., Corydon K.E., et al. Clindamycin treatment of chronic pharyngeal carriage of a group A streptococci. J Pediatr 1991, 119:123-128.
86. Morita J.Y., Kahn E., Thompson T., et al. Impact of azithromycin on oropharyngeal carriage of group A Streptococcus and nasopharyngeal carriage of macrolide-resistant Streptococcus pneumoniae. Pediatr Infect Dis J 2000, 19:41-46.
87. Casey J.R., Pichichero M.E. Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children. Pediatrics 2004, 113:866-882.
88. Gerber M.A., Tanz R.R., Kabat W., et al. Potential mechanism for failure to eradicate group A streptococcal from the pharynx. Pediatrics 1999, 104:911-917.
89. Tewfik T.L., Al Garni M. Tonsillopharyngitis: clinical highlights. J Otolaryngol 2005, 34:S45-S49.
90. Cabrera C.E., Deutsch E.S., Eppes S., et al. Increased incidence of head and neck abscesses in children. Otolaryngol Head Neck Surg 2007, 136:176-181.
91. Abdel-Haq N.M., Harahsheh A., Asmar B.I. Retropharyngeal abscess in children: the emerging role of group A beta hemolytic Streptococcus. Southern Med J 2006, 99:927-931.
92. Johnson R.F., Stewart M.G., Wright C.C. An evidence-based review of the treatment of peritonsillar abscess. Otolaryngol Head Neck Surg 2003, 128:332-343.
93. Craig F.W., Schunk J.E. Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management. Pediatrics 2003, 111:1394-1398.
94. Lander L., Lu S., Shah R.K. Pediatric retropharyngeal abscesses: a national perspective. Int J Pediatric Otorhinolaryngol 2008, 72:1837-1843.
95. Lyon M., Blavies M. Intraoral ultrasound in the diagnosis and treatment of suspected peritonsillar abscess in the emergency department. Acad Emerg Med 2005, 12:85-88.
96. Iverson K., Haritos D., Thomas R., Kannikeswaran N. The effect of bedside ultrasound on diagnosis and management of soft tissue infections in a pediatric ED. Am J Emerg Med 2011 Nov 17, [Epub ahead of print].
97. Johnson R.F., Stewart M.G. The contemporary approach to diagnosis and management of peritonsillar abscess. Curr Opin Otolaryngol Head Neck Surg 2005, 13:157-160.
98. Uzomefuna V., Glynn F., Mackle T., Russel J. Atypical locations of retropharyngeal abscess: beware of the normal lateral soft tissue neck X-ray. Int J Pediatr Otorhinolaryngol 2010, 74:1445-1448.
99. Malloy K.M., Christenson T., Meyer J.S., et al. Lack of association of CT findings and surgical drainage in pediatric neck abscesses. Int J Pediatr Otorhinolaryngol 2008, 72:235-239.
100. Page N.C., Bauer E.M., Lieu J.E.C. Clinical features and treatment of retropharyngeal abscess in children. Otolaryngol Head Neck Surg 2008, 138:300-307.
101. McClay J.E., Murray A.D., Booth T. Intravenous antibiotic therapy for deep neck abscesses defined by computed tomography. Arch Otolaryngol Head Neck Surg 2003, 129:1207-1212.
102. Daya H., Lo S., Papsinb B.C., et al. Retropharyngeal and parapharyngeal infections in children: the Toronto experience. Int J Pediatr Otorhinolaryngol 2005, 69:81-86.
103. Cmejrek R.C., Coticchia J.M., Arnold J.E. Presentation, diagnosis, and management of deep-neck abscesses in infants. Arch Otolaryngol Head Neck Surg 2002, 128:1361-1364.
104. Modayil P.C., Syed I. Addendum to '"Corticosteroids for pain relief in sore throat: systematic review and meta-analysis.". Clin Otolaryngol 2010, 35:241.