今日の臨床サポート

A群レンサ球菌感染症(小児科)

著者: 宮田一平 川崎医科大学小児科学講座

監修: 渡辺博 帝京大学老人保健センター

著者校正/監修レビュー済:2021/07/21
参考ガイドライン:
  1. 日本小児呼吸器学会日本小児感染症学会:小児呼吸器感染症診療ガイドライン 2017
  1. 国際的に脅威となる感染症対策関係閣僚会議:薬剤耐性(AMR)対策アクションプラン 2016-2020. 平成28年4月5日
患者向け説明資料

概要・推奨   

  1. 症状と徴候の組み合わせからA群レンサ球菌感染症をある程度推測することが出来る。
  1. A群レンサ球菌(Streptococcus pyogenes, 化膿レンサ球菌)は小児急性咽頭炎の16~27%を占める主要な原因菌である。
  1. 咽頭迅速検査は短時間で結果を得ることが出来て便利であるが、A群レンサ球菌の確定診断のゴールドスタンダードは培養検査である(推奨度2)。
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧に
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧には
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となりま
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となりま
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧に
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
宮田一平 : 特に申告事項無し[2021年]
監修:渡辺博 : 特に申告事項無し[2021年]

改訂のポイント:
  1. 定期レビューを行い、政府の掲げるAMR対策アクションプラン、小児呼吸器感染症診療ガイドライン2017を踏まえ、第1選択治療薬に関して加筆修正した。
  1. 薬剤耐性に関する情報を更新した。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. A群レンサ球菌感染症の主体は、咽頭炎、扁桃炎である。
  1. A群レンサ球菌による咽頭炎、扁桃炎は5~15歳の小児に多い感染症であるが成人にも認められる。
  1. A群レンサ球菌は小児の急性咽頭炎の20%前後を占める主要な病原微生物であるが、無症候児の5~20%の咽頭からも検出される菌である。
  1. A群レンサ球菌感染症は冬季に多く認められるが、春~初夏にかけて流行を認めることがある。
  1. 咽頭炎・扁桃炎の感染経路は飛沫感染である。
  1. 咽頭炎・扁桃炎の合併症として、扁桃周囲膿瘍、後咽頭膿瘍、化膿性リンパ節炎などがある。
  1. 咽頭炎、扁桃炎の続発症としてリウマチ熱、急性糸球体腎炎、IgA血管炎がある。心臓症状を伴うリウマチ熱は年間発症数10例以下と日本ではまれな疾患となっている[1][2]
  1. まれな続発症として、反応性関節炎と自己免疫性溶連菌関連精神神経障害[3]がある。
  1. A群レンサ球菌の皮膚感染症として、膿痂疹、丹毒、蜂窩織炎がある。皮膚感染症は接触感染で伝播する。
  1. A群レンサ球菌による重症感染症として、壊死性筋膜炎、劇症型レンサ球菌感染症がある。
 
A群レンサ球菌による壊死性筋膜炎

腹部の壊死性筋膜炎 a:急性期 b:感染局所の壊死 c:外科的切除、植皮術施行後 

 
  1. A群レンサ球菌は小児急性咽頭炎の主要な原因菌である。
  1. 海外では、小児の急性咽頭炎の15~30%、成人の急性咽頭炎の5~10%がA群レンサ球菌によるものと報告されている[4]。最近のメタ解析では、通常の外来や救急外来に咽頭痛を主訴に受診した18歳未満の小児の平均37%がA群レンサ球菌感染症であったとされる[5]
  1. 成相らは836名の小児急性咽頭炎患者の咽頭細菌培養の20.9%からA群レンサ球菌が検出されたと報告している。
  1. ただし、流行期には無症候の小児の20%が培養陽性であるとも報告されている[6]
問診・診察のポイント  
  1. 2~4日間の潜伏期間を経て急速に発症する。

今なら12か月分の料金で14ヶ月利用できます(個人契約、期間限定キャンペーン)

11月30日(火)までにお申込みいただくと、
通常12ヵ月の使用期間が2ヶ月延長となり、14ヵ月ご利用いただけるようになります。

詳しくはクリック
本サイトの知的財産権は全てエルゼビアまたはコンテンツのライセンサーに帰属します。私的利用及び別途規定されている場合を除き、本サイトの利用はいかなる許諾を与えるものでもありません。 本サイト、そのコンテンツ、製品およびサービスのご利用は、お客様ご自身の責任において行ってください。本サイトの利用に基づくいかなる損害についても、エルゼビアは一切の責任及び賠償義務を負いません。 また、本サイトの利用を以て、本サイト利用者は、本サイトの利用に基づき第三者に生じるいかなる損害についても、エルゼビアを免責することに合意したことになります。  本サイトを利用される医学・医療提供者は、独自の臨床的判断を行使するべきです。本サイト利用者の判断においてリスクを正当なものとして受け入れる用意がない限り、コンテンツにおいて提案されている検査または処置がなされるべきではありません。 医学の急速な進歩に鑑み、エルゼビアは、本サイト利用者が診断方法および投与量について、独自に検証を行うことを推奨いたします。

文献 

著者: S E Swedo, H L Leonard, M Garvey, B Mittleman, A J Allen, S Perlmutter, L Lougee, S Dow, J Zamkoff, B K Dubbert
雑誌名: Am J Psychiatry. 1998 Feb;155(2):264-71.
Abstract/Text OBJECTIVE: The purpose of this study was to describe the clinical characteristics of a novel group of patients with obsessive-compulsive disorder (OCD) and tic disorders, designated as pediatric autoimmune neuropsychiatric disorders associated with streptococcal (group A beta-hemolytic streptococcal [GABHS]) infections (PANDAS).
METHOD: The authors conducted a systematic clinical evaluation of 50 children who met all of the following five working diagnostic criteria: presence of OCD and/or a tic disorder, prepubertal symptom onset, episodic course of symptom severity, association with GABHS infections, and association with neurological abnormalities.
RESULTS: The children's symptom onset was acute and dramatic, typically triggered by GABHS infections at a very early age (mean = 6.3 years, SD = 2.7, for tics; mean = 7.4 years, SD = 2.7, for OCD). The PANDAS clinical course was characterized by a relapsing-remitting symptom pattern with significant psychiatric comorbidity accompanying the exacerbations; emotional lability, separation anxiety, nighttime fears and bedtime rituals, cognitive deficits, oppositional behaviors, and motoric hyperactivity were particularly common. Symptom onset was triggered by GABHS infection for 22 (44%) of the children and by pharyngitis (no throat culture obtained) for 14 others (28%). Among the 50 children; there were 144 separate episodes of symptom exacerbation; 45 (31%) were associated with documented GABHS infection, 60 (42%) with symptoms of pharyngitis or upper respiratory infection (no throat culture obtained), and six (4%) with GABHS exposure.
CONCLUSIONS: The working diagnostic criteria appear to accurately characterize a homogeneous patient group in which symptom exacerbations are triggered by GABHS infections. The identification of such a subgroup will allow for testing of models of pathogenesis, as well as the development of novel treatment and prevention strategies.

PMID 9464208  Am J Psychiatry. 1998 Feb;155(2):264-71.
著者: Alan L Bisno, Michael A Gerber, Jack M Gwaltney, Edward L Kaplan, Richard H Schwartz, Infectious Diseases Society of America
雑誌名: Clin Infect Dis. 2002 Jul 15;35(2):113-25. doi: 10.1086/340949.
Abstract/Text
PMID 12087516  Clin Infect Dis. 2002 Jul 15;35(2):113-25. doi: 10.1086・・・
著者: Nader Shaikh, Erica Leonard, Judith M Martin
雑誌名: Pediatrics. 2010 Sep;126(3):e557-64. doi: 10.1542/peds.2009-2648. Epub 2010 Aug 9.
Abstract/Text OBJECTIVES: Prevalence estimates can help clinicians make informed decisions regarding diagnostic testing of children who present with symptoms of pharyngitis. We conducted a meta-analysis to determine the (1) prevalence of streptococcal infection among children who presented with sore throat and (2) prevalence of streptococcal carriage among asymptomatic children.
METHODS: We searched Medline for articles on pediatric streptococcal pharyngitis. We included articles in our review when they contained data on the prevalence of group A Streptococcus (GAS) from pharyngeal specimens in children who were younger than 18 years. Two evaluators independently reviewed, rated, and abstracted data from each article. Prevalence estimates were pooled in a meta-analysis and stratified according to age group.
RESULTS: Of the 266 articles retrieved, 29 met all inclusion criteria. Among children of all ages who present with sore throat, the pooled prevalence of GAS was 37% (95% confidence interval [CI]: 32%-43%). Children who were younger than 5 years had a lower prevalence of GAS (24% [95% CI: 21%-26%]). The prevalence of GAS carriage among well children with no signs or symptoms of pharyngitis was 12% (95% CI: 9%-14%).
CONCLUSIONS: Prevalence rates of GAS disease and carriage varied by age; children who were younger than 5 years had lower rates of throat cultures that were positive for GAS.

PMID 20696723  Pediatrics. 2010 Sep;126(3):e557-64. doi: 10.1542/peds.・・・
著者: E L Yoder, J Mendez, R Khatib
雑誌名: Rev Infect Dis. 1987 Mar-Apr;9(2):382-5.
Abstract/Text A 54-year-old man presented with gangrenous myositis caused by Streptococcus pyogenes. A review of the literature disclosed 10 similar cases. Their presenting manifestations were spontaneously occurring, localized, excruciating pain; mottling suggestive of ischemic changes; and signs of sepsis. The duration of illness ranged from two to six days, and the outcome was uniformly fatal. This rare but distinct entity resembles clostridial myonecrosis except that it lasts slightly longer and does not involve gaseous crepitus. A definitive diagnosis of myonecrosi scan be established by surgical exploration; early, radical debridement plus penicillin therapy should be undertaken after diagnosis in an attempt to alter the usual devastating outcome.

PMID 3296102  Rev Infect Dis. 1987 Mar-Apr;9(2):382-5.
著者: Nader Shaikh, Nithya Swaminathan, Emma G Hooper
雑誌名: J Pediatr. 2012 Mar;160(3):487-493.e3. doi: 10.1016/j.jpeds.2011.09.011. Epub 2011 Nov 1.
Abstract/Text OBJECTIVE: To conduct a systematic review to determine whether clinical findings can be used to rule in or to rule out streptococcal pharyngitis in children.
STUDY DESIGN: Two authors independently searched MEDLINE and EMBASE. We included articles if they contained data on the accuracy of symptoms or signs of streptococcal pharyngitis, individually or combined into prediction rules, in children 3-18 years of age.
RESULTS: Thirty-eight articles with data on individual symptoms and signs and 15 articles with data on prediction rules met all inclusion criteria. In children with sore throat, the presence of a scarlatiniform rash (likelihood ratio [LR], 3.91; 95% CI, 2.00-7.62), palatal petechiae (LR, 2.69; CI, 1.92-3.77), pharyngeal exudates (LR, 1.85; CI, 1.58-2.16), vomiting (LR, 1.79; CI, 1.58-2.16), and tender cervical nodes (LR, 1.72; CI, 1.54-1.93) were moderately useful in identifying those with streptococcal pharyngitis. Nevertheless, no individual symptoms or signs were effective in ruling in or ruling out streptococcal pharyngitis.
CONCLUSIONS: Symptoms and signs, either individually or combined into prediction rules, cannot be used to definitively diagnose or rule out streptococcal pharyngitis.

Copyright © 2012 Mosby, Inc. All rights reserved.
PMID 22048053  J Pediatr. 2012 Mar;160(3):487-493.e3. doi: 10.1016/j.j・・・
著者: M H Ebell, M A Smith, H C Barry, K Ives, M Carey
雑誌名: JAMA. 2000 Dec 13;284(22):2912-8.
Abstract/Text CONTEXT: Sore throat is a common complaint, and identifying patients with group A beta-hemolytic streptococcal pharyngitis (strep throat) is an important task for clinicians. Previous reviews have not systematically reviewed and synthesized the evidence.
OBJECTIVE: To review the precision and accuracy of the clinical examination in diagnosing strep throat.
DATA SOURCE: MEDLINE search for articles about diagnosis of strep throat using history-taking and physical examination.
STUDY SELECTION: Large blinded, prospective studies (having > or =300 patients with sore throat) reporting history and physical examination data and using throat culture as the reference standard were included. Of 917 articles identified by the search, 9 met all inclusion criteria.
DATA EXTRACTION: Pairs of authors independently reviewed each article and used consensus to resolve discrepancies.
DATA SYNTHESIS: The most useful findings for evaluating the likelihood of strep throat are presence of tonsillar exudate, pharyngeal exudate, or exposure to strep throat infection in the previous 2 weeks (positive likelihood ratios, 3.4, 2.1, and 1.9, respectively) and the absence of tender anterior cervical nodes, tonsillar enlargement, or exudate (negative likelihood ratios, 0.60, 0.63, and 0.74, respectively). No individual element of history-taking or physical examination is accurate enough by itself to rule in or rule out strep throat. Three validated clinical prediction rules are described for adult and pediatric populations.
CONCLUSIONS: While no single element of history-taking or physical examination is sufficiently accurate to exclude or diagnose strep throat, a well-validated clinical prediction rule can be useful and can help physicians make more informed use of rapid antigen tests and throat cultures.

PMID 11147989  JAMA. 2000 Dec 13;284(22):2912-8.
著者: R M Centor, J M Witherspoon, H P Dalton, C E Brody, K Link
雑誌名: Med Decis Making. 1981;1(3):239-46.
Abstract/Text Adult patients who presented to an urban emergency room complaining of a sore throat had cultures and clinical information recorded. Models were constructed, using logistic regression analysis, of both a positive culture for Group A beta streptococcus and a positive guess by a resident. The model of a positive culture consisted of four variables--tonsillar exudates, swollen tender anterior cervical nodes, lack of a cough, and history of fever. Patients with all 4 variables had a 56% probability of a positive culture; 3 variables, 32%; 2 variables, 15%; 1 variable, 6.5%; and 0 variables, 2.5%. The model of a positive guess by a resident demonstrated an over-reliance on physical exam and an underuse of history. The model of a positive culture allows stratification of patients to assist clinicians in the management strategies.

PMID 6763125  Med Decis Making. 1981;1(3):239-46.
著者: W J McIsaac, V Goel, T To, D E Low
雑誌名: CMAJ. 2000 Oct 3;163(7):811-5.
Abstract/Text BACKGROUND: Reducing the number of antibiotic prescriptions given for common respiratory infections has been recommended as a way to limit bacterial resistance. This study assessed the validity of a previously published clinical score for the management of infections of the upper respiratory tract accompanied by sore throat. The study also examined the potential impact of this clinical score on the prescribing of antibiotics in community-based family practice.
METHODS: A total of 97 family physicians in 49 Ontario communities assessed 621 children and adults with a new infection of the upper respiratory tract accompanied by sore throat and recorded their prescribing decisions. A throat swab was obtained for culture. The sensitivity and specificity of the score approach in this population were compared with previously published results for patients seen at an academic family medicine centre. In addition, physicians' prescribing practices and their recommendations for obtaining throat swabs were compared with score-based recommendations.
RESULTS: Of the 621 cases of new upper respiratory tract infection and sore throat, information about prescriptions given was available for only 619; physicians prescribed antibiotics in 173 (27.9%) of these cases. Of the 173 prescriptions, 109 (63.0%) were given to patients with culture-negative results for group A Streptococcus. Using the score to determine management would have reduced prescriptions to culture-negative patients by 63.7% and overall antibiotic prescriptions by 52.3% (both p < 0.01). Culturing of throat samples would have been reduced by 35.8% (p < 0.01). There was no statistically significant difference in the sensitivity or specificity of the score approach between this community-based population (sensitivity 85.0%, specificity 92.1%) and an academic family medicine centre (sensitivity 83.1%, specificity 94.3%).
INTERPRETATION: An explicit clinical score approach to the management of patients presenting with an upper respiratory tract infection and sore throat is valid in community-based family practice and could substantially reduce the unnecessary prescribing of antibiotics for these conditions.

PMID 11033707  CMAJ. 2000 Oct 3;163(7):811-5.
著者: W A Woods, C T Carter, T A Schlager
雑誌名: Pediatr Emerg Care. 1999 Oct;15(5):338-40.
Abstract/Text OBJECTIVE: To determine the frequency of group A streptococcal pharyngitis in young preschool children presenting to the emergency department with upper respiratory tract infection.
METHODS: A prospective, observational study performed between September 1995 and September 1997. Throat swabs were obtained on young children less than 3 years old with pharyngeal erythema as well as age- and time-matched controls without pharyngeal erythema or exudate. Signs and symptoms that were recorded included: age, temperature, pharyngeal erythema, tonsillar exudate, cervical adenopathy, scarlatini-form rash, rhinorrhea, school-aged child in the home, day care attendance. Swabs were inoculated on 5% sheep blood agar and incubated for 48 hours. Beta-hemolytic colonies were sero-grouped by latex agglutination.
RESULTS: Seventy-eight children with pharyngeal erythema, and 152 controls had pharyngeal specimens obtained and signs or symptoms recorded. Under 2 years of age, the detection of group A streptococci was similar to controls. Detection of group A streptococci was significantly different from controls in children over 2 years of age. Ten (29%) of 35 children over 2 years were positive for group A streptococci compared to 2 (7%) of 29 controls of the same age group (P = 0.03, odds ratio 5, 95% CI: 1.2-24). Findings on clinical examination in children with pharyngeal erythema did not distinguish those that would be culture-positive for group A streptococci.
CONCLUSION: In our emergency department, group A streptococci caused 30% of pharyngitis seen in children between 2 and 3 years of age. Diagnostic testing is recommended because physical examination may not accurately distinguish etiology in this age group.

PMID 10532665  Pediatr Emerg Care. 1999 Oct;15(5):338-40.
著者: Keiji Funahashi, Kazumasa Nakane, Naoko Yasuda, Michio Suzuki, Atsushi Narita, Naoko Arai, Jaekun Ahn, Noriko Koyama, Hajime Ushida, Naoko Nishimura, Takao Ozaki
雑誌名: Jpn J Infect Dis. 2008 Nov;61(6):454-6.
Abstract/Text Group A streptococcus (GAS) is a major cause of pediatric pharyngotonsillitis. In this study we determined the T serotype and antimicrobial susceptibility of GAS isolates from Japanese children. From January to December 2006, a total of 438 isolates of GAS were obtained from pharyngeal swabs of 438 children with pharyngotonsillitis. The commonest T serotype was type 1 (110 strains, 25.1%), followed by type 12 (107, 24.4%) and type 4 (77, 17.6%). All GAS isolated from pharyngeal swabs were susceptible to beta-lactams (benzylpenicillin, amoxicillin, cefotaxime, ceftriaxone, imipenem, panipenem, and cefditoren) and vancomycin, but 19.6, 19.6, 3.2, 11.6, and 27.6% were resistant to erythromycin, clarithromycin, clindamycin, minocycline, and norfloxacin, respectively. Resistance varied considerably with the T serotype. In particular, type 4 isolates had the highest resistance (67.5, 67.5, 26.0, and 53.2% were resistant to erythromycin, clarithromycin, minocycline, and norfloxacin, respectively).

PMID 19050353  Jpn J Infect Dis. 2008 Nov;61(6):454-6.
著者: Miika Bergman, Solja Huikko, Marja Pihlajamäki, Pekka Laippala, Erkki Palva, Pentti Huovinen, Helena Seppälä, Finnish Study Group for Antimicrobial Resistance (FiRe Network)
雑誌名: Clin Infect Dis. 2004 May 1;38(9):1251-6. doi: 10.1086/383309. Epub 2004 Apr 14.
Abstract/Text The aim of this study was to investigate the association between regional macrolide resistance in Streptococcus pyogenes and macrolide use in Finland. During 1997-2001, a total of 50,875 S. pyogenes isolates were tested for erythromycin susceptibility in clinical microbiology laboratories throughout Finland. The local erythromycin resistance levels were compared with the regional consumption data of all macrolides pooled and, separately, with the use of azithromycin. The regional resistance rates of 1 year were compared with the regional consumption of the previous year and with the average rates of use for the 2 previous years. A linear mixed model for repeated measures was used in modeling the association. A statistically significant association existed between regional erythromycin resistance in S. pyogenes and consumption of macrolides; association with azithromycin use alone was not found.

PMID 15127336  Clin Infect Dis. 2004 May 1;38(9):1251-6. doi: 10.1086/・・・
著者: Aaron M Harris, Lauri A Hicks, Amir Qaseem, High Value Care Task Force of the American College of Physicians and for the Centers for Disease Control and Prevention
雑誌名: Ann Intern Med. 2016 Mar 15;164(6):425-34. doi: 10.7326/M15-1840. Epub 2016 Jan 19.
Abstract/Text BACKGROUND: Acute respiratory tract infection (ARTI) is the most common reason for antibiotic prescription in adults. Antibiotics are often inappropriately prescribed for patients with ARTI. This article presents best practices for antibiotic use in healthy adults (those without chronic lung disease or immunocompromising conditions) presenting with ARTI.
METHODS: A narrative literature review of evidence about appropriate antibiotic use for ARTI in adults was conducted. The most recent clinical guidelines from professional societies were complemented by meta-analyses, systematic reviews, and randomized clinical trials. To identify evidence-based articles, the Cochrane Library, PubMed, MEDLINE, and EMBASE were searched through September 2015 using the following Medical Subject Headings terms: "acute bronchitis," "respiratory tract infection," "pharyngitis," "rhinosinusitis," and "the common cold."
HIGH-VALUE CARE ADVICE 1: Clinicians should not perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected.
HIGH-VALUE CARE ADVICE 2: Clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis (for example, persistent fevers, anterior cervical adenitis, and tonsillopharyngeal exudates or other appropriate combination of symptoms) by rapid antigen detection test and/or culture for group A Streptococcus. Clinicians should treat patients with antibiotics only if they have confirmed streptococcal pharyngitis.
HIGH-VALUE CARE ADVICE 3: Clinicians should reserve antibiotic treatment for acute rhinosinusitis for patients with persistent symptoms for more than 10 days, onset of severe symptoms or signs of high fever (>39 °C) and purulent nasal discharge or facial pain lasting for at least 3 consecutive days, or onset of worsening symptoms following a typical viral illness that lasted 5 days that was initially improving (double sickening).
HIGH-VALUE CARE ADVICE 4: Clinicians should not prescribe antibiotics for patients with the common cold.

PMID 26785402  Ann Intern Med. 2016 Mar 15;164(6):425-34. doi: 10.7326・・・
著者: ESCMID Sore Throat Guideline Group, C Pelucchi, L Grigoryan, C Galeone, S Esposito, P Huovinen, P Little, T Verheij
雑誌名: Clin Microbiol Infect. 2012 Apr;18 Suppl 1:1-28. doi: 10.1111/j.1469-0691.2012.03766.x.
Abstract/Text The European Society for Clinical Microbiology and Infectious Diseases established the Sore Throat Guideline Group to write an updated guideline to diagnose and treat patients with acute sore throat. In diagnosis, Centor clinical scoring system or rapid antigen test can be helpful in targeting antibiotic use. The Centor scoring system can help to identify those patients who have higher likelihood of group A streptococcal infection. In patients with high likelihood of streptococcal infections (e.g. 3-4 Centor criteria) physicians can consider the use of rapid antigen test (RAT). If RAT is performed, throat culture is not necessary after a negative RAT for the diagnosis of group A streptococci. To treat sore throat, either ibuprofen or paracetamol are recommended for relief of acute sore throat symptoms. Zinc gluconate is not recommended to be used in sore throat. There is inconsistent evidence of herbal treatments and acupuncture as treatments for sore throat. Antibiotics should not be used in patients with less severe presentation of sore throat, e.g. 0-2 Centor criteria to relieve symptoms. Modest benefits of antibiotics, which have been observed in patients with 3-4 Centor criteria, have to be weighed against side effects, the effect of antibiotics on microbiota, increased antibacterial resistance, medicalisation and costs. The prevention of suppurative complications is not a specific indication for antibiotic therapy in sore throat. If antibiotics are indicated, penicillin V, twice or three times daily for 10 days is recommended. At the present, there is no evidence enough that indicates shorter treatment length.

© 2012 The Authors. Clinical Microbiology and Infection © 2012 European Society of Clinical Microbiology and Infectious Diseases.
PMID 22432746  Clin Microbiol Infect. 2012 Apr;18 Suppl 1:1-28. doi: 1・・・
著者: Janet R Casey, Michael E Pichichero
雑誌名: Pediatrics. 2004 Apr;113(4):866-82.
Abstract/Text OBJECTIVE: To conduct a meta-analysis of randomized, controlled trials of cephalosporin versus penicillin treatment of group A beta-hemolytic streptococcal (GABHS) tonsillopharyngitis in children.
METHODOLOGY: Medline, Embase, reference lists, and abstract searches were conducted to identify randomized, controlled trials of cephalosporin versus penicillin treatment of GABHS tonsillopharyngitis in children. Trials were included if they met the following criteria: patients <18 years old, bacteriologic confirmation of GABHS tonsillopharyngitis, random assignment to antibiotic therapy of an orally administered cephalosporin or penicillin for 10 days of treatment, and assessment of bacteriologic outcome using a throat culture after therapy. Primary outcomes of interest were bacteriologic and clinical cure rates. Sensitivity analyses were performed to assess the impact of careful clinical illness descriptions, compliance monitoring, GABHS serotyping, exclusion of GABHS carriers, and timing of the test-of-cure visit.
RESULTS: Thirty-five trials involving 7125 patients were included in the meta-analysis. The overall summary odds ratio (OR) for the bacteriologic cure rate significantly favored cephalosporins compared with penicillin (OR: 3.02; 95% confidence interval [CI]: 2.49-3.67, with the individual cephalosporins [cephalexin, cefadroxil, cefuroxime, cefpodoxime, cefprozil, cefixime, ceftibuten, and cefdinir] showing superior bacteriologic cure rates). The overall summary OR for clinical cure rate was 2.33 (95% CI: 1.84-2.97), significantly favoring the same individual cephalosporins. There was a trend for diminishing bacterial cure with penicillin over time, comparing the trials published in the 1970s, 1980s, and 1990s. Sensitivity analyses for bacterial cure significantly favored cephalosporin treatment over penicillin treatment when trials were grouped as double-blind (OR: 2.31; 95% CI: 1.39-3.85), high-quality (OR: 2.50; 95% CI: 1.85-3.36) trials with well-defined clinical status (OR: 2.12; 95% CI: 1.54-2.90), with detailed compliance monitoring (OR: 2.85; 95% CI: 2.33-3.47), with GABHS serotyping (OR: 3.10; 95% CI: 2.42-3.98), with carriers eliminated (OR: 2.51; 95% CI: 1.55-4.08), and with test of cure 3 to 14 days posttreatment (OR: 3.53; 95% CI: 2.75-4.54). Analysis of comparative bacteriologic cure rates for the 3 generations of cephalosporins did not show a difference.
CONCLUSIONS: This meta-analysis indicates that the likelihood of bacteriologic and clinical failure of GABHS tonsillopharyngitis is significantly less if an oral cephalosporin is prescribed, compared with oral penicillin.

PMID 15060239  Pediatrics. 2004 Apr;113(4):866-82.
著者: Janet R Casey, Michael E Pichichero
雑誌名: Pediatr Infect Dis J. 2005 Oct;24(10):909-17.
Abstract/Text OBJECTIVE: To compare bacterial and clinical cure rates in patients with group A streptococcal (GAS) tonsillopharyngitis treated with oral beta-lactam or macrolide antibiotics for 4-5 days versus 10-day comparators.
METHODS: Medline, Embase, reference lists and abstract searches were used to identify available publications. Trials were included if there was bacteriologic confirmation of GAS tonsillopharyngitis, random assignment to antibiotic therapy for a beta-lactam or macrolide antibiotic of a shortened course versus a 10-day comparator and assessment of bacteriologic outcome using a throat culture.
RESULTS: Twenty-two trials involving 7470 patients were included in 4 separate analyses. Trials were grouped by a short course of cephalosporins (n = 14), macrolides (other than azithromycin) (n = 6) and penicillin (n = 2). Cephalosporin trials were further grouped by the comparator, penicillin or the same cephalosporin. Short course cephalosporin treatment was superior for bacterial cure rate compared with 10 days of penicillin [odds ratio (OR), 1.47; 95% confidence interval (CI), 1.06-2.03]. For trials with short course macrolide therapy, OR = 0.79 (95% CI 0.59-1.06) neither the macrolides nor the 10-day comparators. Short course penicillin therapy was inferior in achieving bacterial cure versus 10 days of penicillin, OR = 0.29 (95% CI 0.13-0.63). Clinical cure rates mirrored bacteriologic cure rates.
CONCLUSION: Superior cure rates can be achieved with shortened courses of cephalosporin therapy, but 5 days is inferior to 10 days of penicillin treatment.

PMID 16220091  Pediatr Infect Dis J. 2005 Oct;24(10):909-17.
著者: Hiroshi Sakata
雑誌名: J Infect Chemother. 2008 Jun;14(3):208-12. doi: 10.1007/s10156-008-0597-0. Epub 2008 Jun 24.
Abstract/Text In order to compare the bacteriological and clinical efficacy and safety of cefcapene-pivoxil (CFPN-PI) for 5 days, CFPN-PI for 10 days, and amoxicillin (AMPC) for 10 days for the treatment of pharyngitis due to group A beta-hemolytic streptococcus (GAS) in children, a prospective multicenter randomized open-label comparative study was performed with 12 pediatric clinics in Asahikawa between June 2006 and February 2007. Two hundred and fifty children (age range 6 months to 12 years) with signs and symptoms of acute pharyngitis were enrolled. All had a positive throat culture for GAS and were fully evaluable. Eighty-two patients received CFPN-PI 9-10 mg/kg/day three times a day for 5 days, 88 received CFPN-PI three times a day for 10 days, and 80 received AMPC three times a day for 10 days. The CFPN-PI for 5 days regimen, the CFPN-PI for 10 days regimen, and the AMPC for 10 days regimen produced bacteriological eradication at the end of treatment in 93.8%, 96.2%, and 91.7% of the patients, respectively. The clinical cure rate observed at the end of therapy was 100% of the patients in the three groups. Relapse rates were 1.3% in CFPN-PI for 5 days, 4.0% in CFPN-PI for 10 days, and 2.9% in AMPC for 10 days. There were no significant differences in eradication rate, clinical cure rate, and relapse rate between the three treatment groups. The only adverse effects were infrequent diarrhea in all three groups, and a rash which occurred in 6 patients (8.0%) of the AMPC treatment group. Five days of treatment with CFPN-PI was as efficacious in bacteriological eradication and clinical response as 10 days of CFPN-PI or AMPC treatment.

PMID 18574656  J Infect Chemother. 2008 Jun;14(3):208-12. doi: 10.1007・・・
著者: Takao Ozaki, Naoko Nishimura, Michio Suzuki, Atsushi Narita, Naoko Watanabe, Jaekun Ahn, Norio Koyama, Hajime Ushida, Kazumasa Nakane, Naoko Yasuda, Keiji Funahashi
雑誌名: J Infect Chemother. 2008 Jun;14(3):213-8. doi: 10.1007/s10156-008-0602-7. Epub 2008 Jun 24.
Abstract/Text We prospectively compared the efficacy of oral cefditoren-pivoxil and conventional oral amoxicillin for pharyngotonsillitis caused by group A streptococcus in children. Either oral cefditoren-pivoxil (3 mg/kg t.i.d. for 5 days) or amoxicillin (10 mg/kg t.i.d. for 10 days) was administered to patients with group A streptococcal pharyngotonsillitis attending the pediatric outpatient clinic of Showa Hospital (Konan, Japan) between January and December 2006. Diagnosis was based on isolation of bacteria from a pharyngeal swab. Culture was always done to confirm eradication, and urinalysis and follow-up were performed at least once weekly for 4 weeks. Among 258 patients, 103 (aged 5.5 +/- 2.3 years) received cefditoren-pivoxil and 155 (aged 5.2 +/- 2.0 years) received amoxicillin. There were no significant between-group differences in age, sex, or symptoms. Eradication was confirmed in 99% (102/103) of the cefditoren-pivoxil group and 100% of the amoxicillin group. Recurrence within 4 weeks occurred in 8 and 15 patients in the cefditoren-pivoxil and amoxicillin groups, respectively, showing no significant difference in the recurrence rate, and all isolates had the same serotypes as before. There were no clinically significant adverse reactions or complications. The 50%/90% minimum inhibitory concentrations (microg/ml) of cefditoren-pivoxil and amoxicillin for the 258 isolates were < or =0.03/< or =0.03 and < or =0.03/0.06, respectively, so all isolates were susceptible to both agents. Because the efficacy for pediatric group A streptococcus pharyngotonsillitis was similar between oral cefditoren-pivoxil for 5 days and amoxicillin for 10 days, the shorter treatment period may make the former regimen preferable.

PMID 18574657  J Infect Chemother. 2008 Jun;14(3):213-8. doi: 10.1007/・・・
著者: Naoki Tsumura, Kensuke Nagai, Hidenobu Hidaka, Yasushi Otsu, Yuhei Tanaka, Shigeru Ikezawa, Shinichi Honma, Shizuo Shindo, Kimiko Ubukata
雑誌名: Jpn J Antibiot. 2011 Jun;64(3):179-90.
Abstract/Text We compared the clinical efficacy, the bactericidal effects, effect on the oral microbial flora, and adverse reactions between cefditoren pivoxil (CDTR-PI) for 5 days and amoxicillin (AMPC) for 10 days in children with acute group A beta-hemolytic streptococci (GAS) tonsillopharyngitis, and simultaneously examined the emm genotype and drug susceptibility of the isolated GAS. The results showed that the clinical efficacy was 100% for CDTR-PI and 97.9% for AMPC, with no difference between the two groups, and the bacterial elimination rate was 100% in both groups. No serious adverse event was noted in either group. On the other hand, concerning changes in the oral microbial flora between before and after treatment, the amount of bacteria showed no change in the CDTR-PI group (p = 0.5761) but clearly decreased in the AMPC group (p = 0.0049). This indicates that CDTR-PI does not disturb the oral microbial flora compared with AMPC. Also, the emm types determined in the 112 GAS strains isolated in this study were similar to those that have recently been isolated frequently in Japan. Concerning the drug resistance, none of the isolates showed resistance to beta-lactam antibiotics, but 45% of them were resistant to macrolides. The advantages of short-term treatment are considered to include a lower cost, improvement in drug compliance, decrease in the frequency of the occurrence of adverse reactions, decrease in the frequency of the appearance of drug-resistant strains, and alleviation of the psychological burden of patients and their parents. For these reasons, we conclude that CDTR-PI for 5 days is a useful option for the treatment of acute GAS tonsillopharyngitis in children.

PMID 21861309  Jpn J Antibiot. 2011 Jun;64(3):179-90.
著者: Saleh Altamimi, Adli Khalil, Khalid A Khalaiwi, Ruth A Milner, Martin V Pusic, Mohammed A Al Othman
雑誌名: Cochrane Database Syst Rev. 2012 Aug 15;(8):CD004872. doi: 10.1002/14651858.CD004872.pub3. Epub 2012 Aug 15.
Abstract/Text BACKGROUND: The standard duration of treatment for children with acute group A beta hemolytic streptococcus (GABHS) pharyngitis with oral penicillin is 10 days. Shorter duration antibiotics may have comparable efficacy.
OBJECTIVES: To summarize the evidence regarding the efficacy of two to six days of newer oral antibiotics (short duration) compared to 10 days of oral penicillin (standard duration) in treating children with acute GABHS pharyngitis.
SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 3) which contains the Cochrane Acute Respiratory Infections Group's Specialized Register, MEDLINE (January 1966 to March week 3, 2012) and EMBASE (January 1990 to April 2012).
SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing short duration oral antibiotics to standard duration oral penicillin in children aged 1 to 18 years with acute GABHS pharyngitis.
DATA COLLECTION AND ANALYSIS: Two review authors scanned the titles and abstracts of retrieved citations and applied the inclusion criteria. We retrieved included studies in full, and extracted data. Two review authors independently assessed trial quality.
MAIN RESULTS: We included 20 studies with 13,102 cases of acute GABHS pharyngitis. The updated search did not identify any new eligible studies; the majority of studies were at high risk of bias. However, the majority of the results were consistent. Compared to standard duration treatment, the short duration treatment studies had shorter periods of fever (mean difference (MD) -0.30 days, 95% confidence interval (CI) -0.45 to -0.14) and throat soreness (MD -0.50 days, 95% CI -0.78 to -0.22); lower risk of early clinical treatment failure (odds ratio (OR) 0.80, 95% CI 0.67 to 0.94); no significant difference in early bacteriological treatment failure (OR 1.08, 95% CI 0.97 to 1.20) or late clinical recurrence (OR 0.95, 95% CI 0.83 to 1.08). However, the overall risk of late bacteriological recurrence was worse in the short duration treatment studies (OR 1.31, 95% CI 1.16 to 1.48), although no significant differences were found when studies of low dose azithromycin (10 mg/kg) were eliminated (OR 1.06, 95% CI 0.92 to 1.22). Three studies reported long duration complications. Out of 8135 cases of acute GABHS pharyngitis, only six cases in the short duration treatment versus eight in the standard duration treatment developed long-term complications in the form of glomerulonephritis and acute rheumatic fever, with no statistically significant difference (OR 0.53, 95% CI 0.17 to 1.64).
AUTHORS' CONCLUSIONS: Three to six days of oral antibiotics had comparable efficacy compared to the standard duration 10-day course of oral penicillin in treating children with acute GABHS pharyngitis. . In areas where the prevalence of rheumatic heart disease is still high, our results must be interpreted with caution.

PMID 22895944  Cochrane Database Syst Rev. 2012 Aug 15;(8):CD004872. d・・・
著者: D Adam, H Scholz, M Helmerking
雑誌名: J Infect Dis. 2000 Aug;182(2):509-16. doi: 10.1086/315709. Epub 2000 Jul 28.
Abstract/Text A large-scale study with a 1-year follow-up was performed to compare 10 days of penicillin V with a short-course treatment (5 days) of other oral antibiotics in the treatment of group A beta-hemolytic streptococcus (GABHS) tonsillopharyngitis, to evaluate the efficacy and the incidence of poststreptococcal sequelae. The clinical response rates after completion of therapy were 94.5% in the 5-day group and 93.4% in the penicillin group (P<.001, equivalence test). The GABHS eradication rates were 83.3% in the 5-day group and 84.4% in the penicillin group (P=.022, equivalence test). Poststreptococcal sequelae were rare (5 patients) and did not occur in the context of this study. The efficacy of 5-day antibiotic regimens was equivalent to 10 days of penicillin V, but resolution of clinical symptoms was faster in the 5-day group (P<.001, Fisher's exact test). Recurrent tonsillopharyngitis occurs more frequently after treatment with penicillin (P=.03, Fisher's exact test).

PMID 10915082  J Infect Dis. 2000 Aug;182(2):509-16. doi: 10.1086/3157・・・
著者: E M Adams, S Gudmundsson, D E Yocum, R C Haselby, W A Craig, W R Sundstrom
雑誌名: Arch Intern Med. 1985 Jun;145(6):1020-3.
Abstract/Text Two patients had streptococcal myositis. Both patients developed extensive muscle necrosis and overwhelming sepsis after trivial skin trauma. Death occurred within 48 hours of hospital admission despite aggressive surgical and medical treatment. Review of the literature is included to highlight the fulminant nature of this unusual infection and to contrast streptococcal myositis with other soft-tissue streptococcal infections.

PMID 3890787  Arch Intern Med. 1985 Jun;145(6):1020-3.
著者: A L Bisno, D L Stevens
雑誌名: N Engl J Med. 1996 Jan 25;334(4):240-5. doi: 10.1056/NEJM199601253340407.
Abstract/Text
PMID 8532002  N Engl J Med. 1996 Jan 25;334(4):240-5. doi: 10.1056/NE・・・
著者: C G Gemmell, P K Peterson, D Schmeling, Y Kim, J Mathews, L Wannamaker, P G Quie
雑誌名: J Clin Invest. 1981 May;67(5):1249-56.
Abstract/Text Streptococcus pyogenes, bearing M-protein on its surface, resists opsonization by normal human serum and subsequent phagocytosis by human polymorphonuclear leukocytes. Previous studies have shown that M-protein positive organisms are poorly opsonized by the alternate pathway of complement. In an attempt to define further the role of the surface components of S. pyogenes in this process, we examined the ability of clindamycin, an antibiotic that inhibits protein biosynthesis, to alter bacterial opsonization. An M-protein positive strain of S. pyogenes was grown in varying concentrations of clindamycin at levels lower than those which inhibited growth, i.e., at levels less than the minimal inhibitory concentration. These bacteria were incubated with purified human polymorphonuclear leukocytes and peripheral blood monocytes. Significant enhancement of bacterial opsonization, phagocytosis, and killing resulted. Measurement of complement consumption and binding of the third component of complement (C3) onto the bacterial surface demonstrated that organisms grown in the presence of clindamycin activated complement more readily and fixed more C3 on their surface. Electron microscopy revealed the probable basis for these findings. Streptococci exposed to clindamycin during growth were largely denuded of surface "fuzz," the hairlike structures bearing M-protein. We conclude that the incorporation of clindamycin at concentrations that fail to inhibit growth of S. pyogenes nevertheless causes significant changes in the capacity of these bacteria to resist opsonization by serum complement. These findings support the hypothesis that M-protein inhibits bacterial opsonization by interfering with effective complement activation on the bacterial surface.

PMID 7014632  J Clin Invest. 1981 May;67(5):1249-56.
著者: D L Stevens
雑誌名: Emerg Infect Dis. 1995 Jul-Sep;1(3):69-78. doi: 10.3201/eid0103.950301.
Abstract/Text Since the 1980s there has been a marked increase in the recognition and reporting of highly invasive group A streptococcal infections with or without necrotizing fasciitis associated with shock and organ failure. Such dramatic cases have been defined as streptococcal toxic-shock syndrome. Strains of group A streptococci isolated from patients with invasive disease have been predominantly M types 1 and 3 that produce pyrogenic exotoxin A or B or both. In this paper, the clinical and demographic features of streptococcal bacteremia, myositis, and necrotizing fasciitis are presented and compared to those of streptococcal toxic-shock syndrome. Current concepts in the pathogenesis of invasive streptococcal infection are also presented, with emphasis on the interaction between group A Streptococcus virulence factors and host defense mechanisms. Finally, new concepts in the treatment of streptococcal toxic-shock syndrome are discussed.

PMID 8903167  Emerg Infect Dis. 1995 Jul-Sep;1(3):69-78. doi: 10.3201・・・
著者: J Zimbelman, A Palmer, J Todd
雑誌名: Pediatr Infect Dis J. 1999 Dec;18(12):1096-100.
Abstract/Text CONTEXT: Animal model studies have demonstrated the failure of penicillin to cure Streptococcus pyogenes myositis and have suggested that clindamycin is a more effective treatment.
OBJECTIVE: To determine the most effective antibiotic treatment for invasive S. pyogenes infection in humans.
DESIGN AND SETTING: We conducted a retrospective review of the outcomes of all inpatients from 1983 to 1997 treated for invasive S. pyogenes infection at Children's Hospital.
PATIENTS: Fifty-six children were included, 37 with initially superficial disease and 19 with deep or multiple tissue infections.
MAIN OUTCOME MEASURE: Lack of progression of disease (or improvement) after at least 24 h of treatment.
RESULTS: The median number of antibiotic exposures was 3 per patient (range 1 to 6) with clindamycin predominating in 39 of 45 courses of protein synthesis-inhibiting antibiotics and beta-lactams predominating amongst the cell wall-inhibiting antibiotics in 123 of 126 of the remainder. Clindamycin was often used in combination with a beta-lactam antibiotic. Overall there was a 68% failure rate of cell wall-inhibiting antibiotics when used alone. Patients with deep infection were more likely to have a favorable outcome if initial treatment included a protein synthesis-inhibiting antibiotic as compared with exclusive treatment with cell wall-inhibiting antibiotics (83% vs. 14%, P = 0.006) with a similar trend in those with superficial disease (83% vs. 48%, P = 0.07). For those children initially treated with cell wall-inhibiting antibiotics alone, surgical drainage or debridement increased the probability of favorable outcome in patients with superficial disease (100% vs. 41%, P = 0.04) with a similar trend in a smaller number of deep infections (100% vs. 0%, P = 0.14).
CONCLUSIONS: This retrospective study suggests that clindamycin in combination with a beta-lactam antibiotic (with surgery if indicated) might be the most effective treatment for invasive S. pyogenes infection.

PMID 10608632  Pediatr Infect Dis J. 1999 Dec;18(12):1096-100.
著者: Dennis L Stevens, Alan L Bisno, Henry F Chambers, E Dale Everett, Patchen Dellinger, Ellie J C Goldstein, Sherwood L Gorbach, Jan V Hirschmann, Edward L Kaplan, Jose G Montoya, James C Wade, Infectious Diseases Society of America
雑誌名: Clin Infect Dis. 2005 Nov 15;41(10):1373-406. doi: 10.1086/497143. Epub 2005 Oct 14.
Abstract/Text
PMID 16231249  Clin Infect Dis. 2005 Nov 15;41(10):1373-406. doi: 10.1・・・
著者: Tadayoshi Ikebe, Akihito Wada, Yuuko Oguro, Kikuyo Ogata, Chihiro Katsukawa, Junko Isobe, Tomoko Shima, Rieko Suzuki, Hitomi Ohya, Kiyoshi Tominaga, Rumi Okuno, Yumi Uchitani, Haruo Watanabe, Working Group for Beta-hemolytic Streptococci in Japan
雑誌名: Jpn J Infect Dis. 2010 Jul;63(4):304-5.
Abstract/Text
PMID 20657078  Jpn J Infect Dis. 2010 Jul;63(4):304-5.
著者: Shigeki Nakamura, Katsunori Yanagihara, Yukihiro Kaneko, Hideaki Ohno, Yasuhito Higashiyama, Yoshitsugu Miyazaki, Youichi Hirakata, Kszunori Tomono, Takayoshi Tashiro, Shigeru Kohno
雑誌名: Kansenshogaku Zasshi. 2004 May;78(5):446-50.
Abstract/Text A 53-year-old male was admitted to our hospital with a high fever and pain in the right arm. He was diagnosed as toxic shock-like syndrome by Streptococcus pyogenes. His arm was amputated because of necrotizing myositis and his renal damage was severe, he was treated in the intensive care unit with continuous hemodiafiltration. Bacteria were isolated from blood, ascites, pleural effusion, skin, and muscle. He was treated with a large amount of ampicillin, clindamycin, and gammaglobulin. However, his general status became worse. His illness improved after linezolid was administered. The reason for the success in treatment with linezolid, which was the inhibitory effect on bacterial toxin and its excellent penetration into the tissue.

PMID 15211868  Kansenshogaku Zasshi. 2004 May;78(5):446-50.
著者: Hideaki Kikuta, Mutsuo Shibata, Shuji Nakata, Tatsuru Yamanaka, Hiroshi Sakata, Kozo Fujita, Kunihiko Kobayashi
雑誌名: Pediatr Infect Dis J. 2007 Feb;26(2):139-41. doi: 10.1097/01.inf.0000253060.72953.9d.
Abstract/Text BACKGROUND: The role of chemoprophylaxis for household contacts of patients with acute streptococcal disease is uncertain.
METHODS: The subjects were 1440 sibling contacts of 1181 index patients with group A beta-hemolytic streptococcal (GABHS) pharyngitis. Instances of subsequent GABHS pharyngitis in sibling contacts who received chemoprophylaxis and in a control group without prophylaxis were compared.
RESULTS: Of the 948 siblings in the prophylaxis group, 507 were treated with cephalosporins and 441 were treated with penicillins for 3 to 5 days. Subsequent GABHS pharyngitis occurred within 30 days in 28 (3.0%) of the 948 siblings in the prophylaxis group and in 26 (5.3%) of the 492 siblings in the control group. Among siblings in the prophylaxis group, subsequent GABHS pharyngitis occurred in 9 (1.8%) of the 507 siblings in the cephalosporin prophylaxis group and in 19 (4.3%) of the 441 siblings in the penicillin prophylaxis group. When these data were each compared with that in the control group (5.3%), a significant statistical difference was seen in the cephalosporin prophylaxis group (P = 0.003) but not in the penicillin prophylaxis group (P = 0.542). Only 5-day cephalosporin prophylaxis showed significant reduction in the rate of subsequent GABHS pharyngitis compared with that in the control group (P = 0.002).
CONCLUSIONS: In view of the low incidence of subsequent GABHS pharyngitis in the nonprophylaxis group, the usual self-limited nature of GABHS pharyngitis, the cost of prophylaxis and the risk for selecting resistant flora, routine chemoprophylaxis against GABHS pharyngitis for sibling contacts is not recommended.

PMID 17259876  Pediatr Infect Dis J. 2007 Feb;26(2):139-41. doi: 10.10・・・

ページ上部に戻る

戻る

さらなるご利用にはご登録が必要です。

こちらよりご契約または優待日間無料トライアルお申込みをお願いします。

(※トライアルご登録は1名様につき、一度となります)


ご契約の場合はご招待された方だけのご優待特典があります。

以下の優待コードを入力いただくと、

契約期間が通常12ヵ月のところ、14ヵ月ご利用いただけます。

優待コード: (利用期限:まで)

ご契約はこちらから