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ISRN Pediatrics
Volume 2012 (2012), Article ID 796389, 8 pages
http://dx.doi.org/10.5402/2012/796389
Clinical Study

Streptococcal Pharyngitis: A Prospective Study of Compliance and Complications

1Pediatric and Adolescent Ambulatory Community Clinics-Clalit Health Care Services, 128 Alozorov Street, Tel-Aviv, Israel
2IPROS Network of the Israel Ambulatory Pediatrics Association, Israel Ambulatory Pediatric Association, Tel-Aviv, Israel
3Department of Family Practice, Clalit Health Services HMO, Sharon-Shomron District and Department of Family Practice, Tel-Aviv University, Tel-Aviv, Israel

Received 1 April 2012; Accepted 28 April 2012

Academic Editors: J. A. O'Neill and N. A. Shorter

Copyright © 2012 E. Michael Sarrell and Shmuel M. Giveon. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Uncertainty exists concerning the necessity of 10-day antibiotic treatment of group A beta hemolytic streptococcus (GABHS) pharyngitis. Objective. To assess the incidence of GABHS recurrence and suppurative and nonsuppurative complications in relation to compliance. Methods. (Design). Prospective cohort observational study. (Subjects). 2,000 children aged 6 months to 18 years with sore throat and positive GABHS culture. (Main Outcome Measures). Recurrence of symptomatic culture positive GABHS pharyngitis, incidence of suppurative, and long-term, regional, nonsuppurative complications of GABHS pharyngitis, over a ten year period. Results. 213 (11%) of the children received no treatment. Most children received antibiotics for only 4–6 days (in correlation with the duration of fever, which in most cases lasted up to 3 days). Three hundred and six (15.3%) children had clinically diagnosed recurrent tonsillopharyngitis; 236 (12.3%) had positive GABHS findings within 10 to 14 days and thirty-four (1.7%) within 21–30 days after the index positive GABHS culture. The remaining 1.3% had no positive culture despite the clinical findings. Almost all recurrences [236 (11.6%)] occurred within 14 days and 156 (7.6%) in the fully treated group. The presence of fever during the first 3 days of the disease was the most significant predictor for recurrence. Other predictors were the age younger than 6 years and the presence of cervical lymphadenitis. No increase in the incidence of nonsuppurative or suppurative complications was noted during the 10-year follow-up period, compared to the past incidence of those complications in Israel. Conclusions. Our data suggests that the majority of children discontinue antibiotics for GABHS tonsillopharyngitis a day or two after the fever subsides. The incidence of complications in our study was not affected by this poor compliance.