What's new in streptococcal pharyngitis

Upper respiratory tract infections are most frequent reason for a visit to a paediatrician. In Italy more than 5 million visits are made by children annually for pharyngitis and in 86% of cases an antibiotic is prescribed. Prevention of acute rheumatic fever (ARF) has been a consideration in deciding whether to treat acute pharyngitis. Because ARF is increasingly rare and the prevalence of group A beta haemolytic streptococci (GABHS) in acute sore throat is only 20-30%, more than 70 000 patient treatments would be required to prevent one case of ARF. Failure of a standard 10-day course with penicillin V may be due to penicillin tolerance or increased virulence of the GABHS strain, inactivation by beta lactamases liberated in the tonsillary area by indigenous flora, or to non-compliance with treatment.