[Antibiotic treatment of pharyngitis]

Antimicrobial therapy of pharyngitis focuses mainly on eradicating group A streptococci and treating recurrent pharyngitis. The French strategy rests on routine treatment of all cases of childhood pharyngitis; in the United-States, rapid tests are used to identify group A streptococci in the throat before treating. Antibiotics used against group A streptococci include beta-lactams and macrolides. Among beta-lactams, the reference drug is still penicillin, e.g., penicillin V for 10 days. However, numbers of carriers with positive throat cultures for Streptococcus pyogenes seem to be growing in the United States, with a 10-20% increase over the last twenty years. Duration of therapy could be reduced from 10 to 5 days with the new oral cephalosporins but these drugs are more expensive than penicillin. Recurrent pharyngitis is caused by a variety of organisms which are often penicillinase-producers. It follows that penicillin should not be used in these cases, which require oral cephalosporins or the amoxicillin-clavulanic acid combination. Maintenance antimicrobial therapy between acute episodes should be considered.