Manejo de la faringoamigdalitis estreptocóccica en pacientes adultos o adolescentes
Streptococcal pharyngitis is an important cause of morbidity and a common reason of antibiotic missuse. No more than 10 to 15% of adults that consult for acute sore throat and fever have a definite Group A streptococcal (GAS) pharyngitis. Inappropriate treatment exposes patients to allergic reactions, other adverse events and increased health care costs. Where rheumatic fever is declining and/or infrequent as observed in Chile, appropriate demonstration of GAS by rapid test or throat culture is the most logical approach. Rapid tests provide a good sensitivity (80-90%) and specificity (95-99%) to detect GAS pharyngitis. These tests can be applied at a reasonable cost and negative results can be further confirmed by culture. Several therapeutic options are now available to eradicate GAS from pharynx, a subsidiary marker of efficacy to protect patients from rheumatic fever. These alternatives do not significantly improve the efficacy obtained with oral penicillin V, have similar frequencies of adverse events and are characterized by an meaningful increase in acquisition costs. On the other hand, schemes based on oral amoxicillin or intramuscular penicillin G benzathine have similar costs than the standard treatment. Abbreviated courses of therapies using different compounds for 5 or 6 days, have similar efficacy to standard therapy but do not reduce the overall cost of treatment.