[Pharyngitis in children]

The care strategy of pharyngitis has been changed dramatically these last years. Because of evolution of antibiotic resistance, the attitude which prevailed of the systematic treatment of pharyngitis in order to prevent a hypothetical acute rheumatic fever, could not persist. Discrimination between pharyngitis due to group A streptococcus (GAS) and nonstreptococcal pharyngitis (usually of viral causes) cannot be made in a reliable way by the clinical signs and symptoms, even if clinical scores are used. The free availability to practitioners of GAS rapid diagnostic tests, sensitive (>90%) and specific (>95%), changes the rule by simplifying it: pharyngitis with positive test must be treated with antibiotics, those with negative test should not be received such treatment. A reduction of two thirds of antibiotics consumption for pharyngitis can be expected, while maintaining the benefit (improvement of the clinical signs, reduction of contagiousness and the complications) for the patients for whom it is necessary. Because of GAS resistance to macrolides and the absence of resistance to beta-lactam antibiotics, a compound belonging of this last family should be prescribed and for a short treatment duration: amoxicillin (50 mg/kg/j, b.i.d for 6 days), cefpodoxime proxetil (8 mg/kg/j b.i.d for 5 days), cefuroxime axetil (30 mg/kg/j b.i.d for 4 days).