MANAGING SORE THROAT - A LITERATURE-REVIEW .1. MAKING THE DIAGNOSIS

被引:44
作者
DELMAR, C [1 ]
机构
[1] UNIV QUEENSLAND,SCH MED,DEPT SOCIAL & PREVENT MED,HERSTON,QLD 4006,AUSTRALIA
关键词
D O I
10.5694/j.1326-5377.1992.tb121422.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To assess the justification for the routine use of investigations in the diagnosis of bacterial causes of sore throat. Data sources: The literature from 1945 to 1990 was systematically screened to identify studies that addressed diagnosis of bacterial infection and the efficacy of antibiotics in sore throat, using the key-words "pharyngitis" and "tonsillitis". Results: Difficulties were identified with clinical methods and investigations that identify streptococcal infections. The practice of throat-swab culture - the "gold standard" - appears to have developed as a strategy to protect patients from acute rheumatic fever. However, this method may be limited in its usefulness for protection against acute rheumatic fever because: (i) in many cases in which the streptococcus is isolated from symptomatic patients there is no serological evidence of infection; (ii) there are very high asymptomatic carrier rates of the streptococcus; (iii) even after adequate treatment with penicillin there are high bacteriological failure rates; and (iv) those organisms lying deep in the tissues. Evaluation of other diagnostic techniques such as Gram's stain and rapid antigen testing, as well as decision analysis, has also been hampered by the difficulties encountered with use of this inadequate gold standard. Conclusion: There is little indication from the literature that any routine system of identifying bacterial causes of sore throat is helpful to the clinician.
引用
收藏
页码:572 / 575
页数:4
相关论文
共 58 条
[1]  
BAIN DJG, 1978, J FAM PRACTICE, V6, P259
[2]  
BERGER PC, 1989, CAN J PUBLIC HEALTH, V80, P38
[3]   SIMPLE SCORECARD FOR TENTATIVE DIAGNOSIS OF STREPTOCOCCAL PHARYNGITIS [J].
BREESE, BB .
AMERICAN JOURNAL OF DISEASES OF CHILDREN, 1977, 131 (05) :514-517
[4]   RESPIRATORY DISEASES IN AUSTRALIAN MORBIDITY SURVEY, 1969-1970 [J].
BRIDGESWEBB, C .
MEDICAL JOURNAL OF AUSTRALIA, 1971, 2 (23) :1175-+
[5]  
BRIDGESWEBB C, 1972, AUST FAM PHYSICIAN, V1, P347
[6]   MEDICAL-TREATMENT OF NON-STREPTOCOCCAL RECURRENT TONSILLITIS [J].
BROOK, I .
AMERICAN JOURNAL OF OTOLARYNGOLOGY, 1989, 10 (04) :227-233
[7]   SURFACE VS CORE-TONSILLAR AEROBIC AND ANAEROBIC FLORA IN RECURRENT TONSILLITIS [J].
BROOK, I ;
YOCUM, P ;
SHAH, K .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1980, 244 (15) :1696-1698
[8]  
CAPLAN C, 1979, J FAM PRACTICE, V8, P485
[9]   THE ROLE OF THE STREPTOCOCCUS IN THE PATHOGENESIS OF RHEUMATIC FEVER [J].
CATANZARO, FJ ;
STETSON, CA ;
MORRIS, AJ ;
CHAMOVITZ, R ;
RAMMELKAMP, CH ;
STOLZER, BL ;
PERRY, WD .
AMERICAN JOURNAL OF MEDICINE, 1954, 17 (06) :749-756
[10]   OCCURRENCE AND PREVENTION OF RHEUMATIC-FEVER AMONG ETHNIC-GROUPS OF HAWAII [J].
CHUN, LT ;
REDDY, V ;
RHOADS, GG .
AMERICAN JOURNAL OF DISEASES OF CHILDREN, 1984, 138 (05) :476-478