TREATMENT FAILURES AND CARRIERS - PERCEPTION OR PROBLEMS
TREATMENT FAILURES AND CARRIERS - PERCEPTION OR PROBLEMS
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DOI：
10.1097/00006454-199406000-00036
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发表时间：
1994-06-01
影响因子：
3.6
通讯作者：
GERBER, MA
中科院分区：
文献类型：
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作者：
GERBER, MA
如果患者在A组溶血性链球菌(GABHS)咽炎的抗生素治疗后出现症状或咽部培养呈GABHS阳性，对于执业儿科医生来说，常见的问题是RS是一名6岁的男性，从出生起就一直在跟踪您。他身体很好，没有什么重大的健康问题。3月初，他被带到你的办公室，在过去的36个小时里，他的主诉是喉咙痛、发烧、头痛和颈部扁桃体疼痛。在检查时，他有明显的咽部注射，扁桃体上有白色渗出物，腭骨和多发肿大、触痛的颈部结节。快速抗原检测呈阳性，并给他开了为期10天的青霉素V疗程的处方。在开始青霉素治疗的48小时内，他完全没有症状。然而，在完成青霉素治疗4天后(依从性良好)，他出现咳嗽、鼻漏和结膜炎。因为这是一个星期天的早上，他的母亲带他去了一家无预约的医疗中心，在那里，快速抗原检测再次呈阳性，并给他开了一张10天疗程的头孢克洛处方。第二天早上，他的母亲打电话给你的办公室，询问为什么她的儿子对青霉素没有反应，以及她是否应该继续使用头孢克洛。青霉素治疗失败的GABHS pharyn-GITIS传统上被归类为“临床”或“细菌学”。临床治疗失败的分析因一些令人困惑的问题而变得复杂：(1)当GABHS咽炎是一种自限性疾病时，即使没有治疗，也很难确定持续或复发的明显链球菌性咽炎的临床意义“；(2)在没有分离GABHS感染株的情况下，很难确定持续或复发的明显链球菌性咽炎的临床意义。
What to do with a patient who, after a course of antibiotic therapy for group A beta-hemolytic streptococcal (GABHS) pharyngitis, is symptomatic or has a positive throat culture for GABHS is a common problem for the practicing pediatrician RS is a 6-year-old male who has been followed by you since birth. He is in good health with no signifi-cant medical problems. In early March he is brought to your office with a complaint of sore throat, fever, headache and tender “glands" in his neck for the past 36 hours. On examination he has marked pharyngeal injection, whitish exudates on his tonsils, palatal pe-techiae and multiple enlarged, tender cervical nodes. A rapid antigen detection test is positive and he is given a prescription for a 10-day course of penicillin V. Within 48 hours of initiating the penicillin therapy, he is entirely asymptomatic. However, 4 days after completing the penicillin therapy (with good compli-ance) he develops a cough, rhinorrhea and conjunctivitis. Because it is a Sunday morning his mother brings him to a walk-in medical center where a rapid antigen detection test is again positive and he is given a prescription for a 10-day course of cefaclor. The following morning his mother calls your office and asks why her son failed to respond to the penicillin and if she should continue the cefaclor. Penicillin treatment failures with GABHS pharyn-gitis have traditionally been classified as either “clin-ical" or “bacteriologic." An analysis of clinical treat-ment failures is complicated by a number of confound-ing issues:(1) it is difficult to determine the clinical significance of persistent or recurrent signs or symptoms of apparent streptococcal pharyngitis when GABHS pharyngitis is a self-limited illness even with-out therapy"*;(2) it is difficult to determine the clinical significance of persistent or recurrent signs or symptoms of apparent streptococcal pharyngitis in the absence of isolation of the infecting strain of GABHS