lunes, 2 de marzo de 2009

Revisión del diagnóstico y tratamiento de la faringitis estreptocócica

La American Family Physician publica una revisión del diagnóstico y tratamiento de la faringitis estreptocócica. Entre las recomendaciones clínicas figuran:

- El uso de reglas de decisión clínica, como la puntuación modificada de los criterios de CENTOR, para diagnosticar infección por estreptococo beta-hemolítico del grupo A, puede reducir los tratamientos innecesarios con antibióticos y el coste añadido.

- La penicilina es el antibiótico indicado para el tratamiento de la faringitis estreptocócica.

- El tratamiento para los portadores crónicos de estreptococo generalmente no se justifica.

La revisión también presenta directrices para la dosificación de la penicilina y otros antibióticos, tanto para niños como para adultos.
Aquí está el abstract:

Diagnosis and treatment of streptococcal pharyngitis.
Choby BA
March 1, 2009 Vol. 79 No. 5


Common signs and symptoms of streptococcal pharyngitis include sore throat, temperature greater than 100.4°F (38°C), tonsillar exudates, and cervical adenopathy. Cough, coryza, and diarrhea are more common with viral pharyngitis. Available diagnostic tests include throat culture and rapid antigen detection testing. Throat culture is considered the diagnostic standard, although the sensitivity and specificity of rapid antigen detection testing have improved significantly. The modified Centor score can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing, or empiric antibiotic therapy. Penicillin (10 days of oral therapy or one injection of intramuscular benzathine penicillin) is the treatment of choice because of cost, narrow spectrum of activity, and effectiveness. Amoxicillin is equally effective and more palatable. Erythromycin and first-generation cephalosporins are options in patients with penicillin allergy. Increased group A beta-hemolytic streptococcus (GABHS) treatment failure with penicillin has been reported. Although current guidelines recommend first-generation cephalosporins for persons with penicillin allergy, some advocate the use of cephalosporins in all nonallergic patients because of better GABHS eradication and effectiveness against chronic GABHS carriage. Chronic GABHS colonization is common despite appropriate use of antibiotic therapy. Chronic carriers are at low risk of transmitting disease or developing invasive GABHS infections, and there is generally no need to treat carriers. Whether tonsillectomy or adenoidectomy decreases the incidence of GABHS pharyngitis is poorly understood. At this time, the benefits are too small to outweigh the associated costs and surgical risks. (Am Fam Physician. 2009;79(5):383-390. Copyright © 2009 American Academy of Family Physicians.)
Full Article - Access restricted to AAFP members and AFP paid subscribers.


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