ESCMID Guideline for the Management of Acute Sore Throat
CLINICAL MICROBIOLOGY AND INFECTION
VOLUME 18, SUPPLEMENT 1, APRIL 2012
C. Pelucchi1, L. Grigoryan2,3, C. Galeone1,4, S. Esposito5, P. Huovinen6,7, P. Little8 and T. Verheij
・細菌性咽頭炎の病原菌： Streptococcus pyogenes (group A b-haemolytic streptococcus), groups C or G b-haemolytic streptococci, Mycoplasma pneumonia, Chlamydia pneumonia
・冬には20%以上の通学小児が無症候性にgroup A streptococcusを保菌
・保菌率： 14 years or less (10.9%), 15-44歳(2.3%), 45歳以上(0.6%)
・合併症は稀：
1)suppurative (i.e. quinsy, acute otitis media, cervical lymphadenitis, mastoiditis, acute sinusitis)
2)non-suppurative (i.e. acute rheumatic fever, acute glomerulonephritis)
A群溶連菌の診断での臨床スコアリングの役割
What is the role of clinical scoring in the diagnosis of group A streptococcal infections?
→有用だが小児では成人と比較して利便性が低い
The Centor clinical scoring system can help to identify those patients who have higher likelihood of group A streptococcal infection (A-3). However, its utility in children appears lower than in adults because of the different clinical presentation of sore throat in the first years of life.
1)センタースコア
tonsillar exudates
swollen tender anterior cervical nodes
the lack of cough
fever.
Risk of group A streptococcal infection (%)
4点：56% 3点：32% 2点：15％ 1点：6.5％ 0点：2.5％
→成人でのみ適応
年齢を考慮したModified criteria
Temperature >38度 1
No cough 1
Tender anterior cervical adenopathy 1
Tonsillar swelling or exudate 1
Age 3–14 years +１
Age 15–44 years 0
Age >44 years ) -1
Total score Risk of group A streptococcal infection (%)
4 点（51–53％） 3点（28–35％）2点（11–17％）1点（5–10％）0点（1-2.5%）
A群溶連菌の診断に対して咽頭培養は必要か？
Is throat culture considered a necessary clinical instrument for diagnosis of group A streptococci?
→ルーチンでは必要ない（時間がかかるため）
Throat culture is not necessary for routine diagnosis of acute sore throat to detect group A streptococci (C-3).
A群溶連菌に対する妥当性があり、正確な診断検査は？ RAT陰性後咽頭培養を行う必要があるか？
What is the validity and accuracy of near patient diagnostic tests for group A streptococcus? Is it necessary to perform a throat culture after a negative RAT for the diagnosis of group A streptococci?
→RATが陰性であれば必要ない。
If RAT is performed, throat culture is not necessary after a negative RAT for the diagnosis of group A streptococci in both children and adults (B-2).
RAT 感度86-94.8% 特異度95% (採取手技により影響を受ける)
posterior pharyngeal wall and both tonsilから採取
A群溶連菌に対する高い臨床スコアではRATの診断価値があがるか？
Is the diagnostic value of RAT increased when tests are performed in subjects with high clinical scores for group A streptococci, i.e. indicators that increase the likelihood of strep throat, as Centor score or modified Centor score?
→上昇する。
In patients with a high likelihood of streptococcal infections (e.g. 3–4 Centor criteria) physicians can consider the use of RATs. In patients with lower likelihood of streptococcal infections (e.g. 0–2 Centor criteria) there is no need to routinely use RATs (B-3).
急性咽頭痛の重症度アセスメントでCRP, プロカルシトニンの役割は？
Is there role for additional tests (e.g. C-reactive protein, procalcitonin measurements) in the assessment of severity of acute sore throat? Does clinical information combined with biomarker information provide better prognostic information?
→必要ない。
It is not necessary, based on current evidence, to routinely
use biomarkers in the assessment of acute sore throat (C-3).
診断テストは抗菌薬使用を改善させるか？
Does improved diagnosis or the use of near patient tests improve
antibiotic use？
→有用である。Clinical scoring systems and rapid tests can be helpful in targeting antibiotic use (B-2).
鎮痛薬は咽頭痛に有効か？
Are analgesics effective in sore throat?
→推奨される。
Either ibuprofen or paracetamol are recommended for relief of acute sore throat symptoms (A-1).
咽頭痛での副腎皮質ステロイドの使用指針は？
What are the indications for use of glucocorticoids in sore throat?
→ルーチンでは推奨されないが、成人で症状が強い場合には考慮される。
Use of corticosteroids in conjunction with antibiotic therapy is not routinely recommended for treatment of sore throat. It can, however, be considered in adult patients with severe presentations, e.g. 3–4 Centor criteria (A-1).
Zinc gluconateの使用指針は？
What are the indications for use of zinc gluconate in the treatment of sore throat?
→推奨されない。
Zinc gluconate is not recommended to be used in the treatment of sore throat (B-2).
Complementary treatmentsの指針は？
What are the indications for complementary treatments, e.g. herbal treatments or acupuncture in sore throat？
→一致したデータなし。There is inconsistent evidence of herbal treatments and acupuncture as treatments for sore throat (C-1 to C-3).
抗菌薬治療の平均効果と抗菌薬治療の恩恵を受けるグループは？
What is the average benefit from antibiotics and which groups of patients benefit from antibiotic treatment?
→low riskでは推奨されない。通常の大部分では抗菌薬治療は必要なし。
Sore throat should not be treated with antibiotics to prevent the development of rheumatic fever and acute glomerulonephritis in low-risk patients (A-1). The prevention of suppurative complications is not a specific indication for
antibiotic therapy in sore throat (A-1). Clinicians do not need to treat most cases of acute sore throat to prevent quinsy, acute otitis media, cervical lymphadenitis, mastoiditis or acute sinusitis (A-3).
抗菌薬は咽頭痛の症状を改善させるか？
Do antibiotics relieve symptoms in sore throat?
→使用するならばpenicillin V 2回又は3回 10日間。治療期間短縮のエビデンスはない。
If antibiotics are indicated, penicillin V, twice or three times daily for 10 days, is recommended (A-1). There is not enough evidence that indicates shorter treatment
Length
CLINICAL MICROBIOLOGY AND INFECTION
VOLUME 18, SUPPLEMENT 1, APRIL 2012
C. Pelucchi1, L. Grigoryan2,3, C. Galeone1,4, S. Esposito5, P. Huovinen6,7, P. Little8 and T. Verheij
・細菌性咽頭炎の病原菌： Streptococcus pyogenes (group A b-haemolytic streptococcus), groups C or G b-haemolytic streptococci, Mycoplasma pneumonia, Chlamydia pneumonia
・冬には20%以上の通学小児が無症候性にgroup A streptococcusを保菌
・保菌率： 14 years or less (10.9%), 15-44歳(2.3%), 45歳以上(0.6%)
・合併症は稀：
1)suppurative (i.e. quinsy, acute otitis media, cervical lymphadenitis, mastoiditis, acute sinusitis)
2)non-suppurative (i.e. acute rheumatic fever, acute glomerulonephritis)
A群溶連菌の診断での臨床スコアリングの役割
What is the role of clinical scoring in the diagnosis of group A streptococcal infections?
→有用だが小児では成人と比較して利便性が低い
The Centor clinical scoring system can help to identify those patients who have higher likelihood of group A streptococcal infection (A-3). However, its utility in children appears lower than in adults because of the different clinical presentation of sore throat in the first years of life.
1)センタースコア
tonsillar exudates
swollen tender anterior cervical nodes
the lack of cough
fever.
Risk of group A streptococcal infection (%)
4点：56% 3点：32% 2点：15％ 1点：6.5％ 0点：2.5％
→成人でのみ適応
年齢を考慮したModified criteria
Temperature >38度 1
No cough 1
Tender anterior cervical adenopathy 1
Tonsillar swelling or exudate 1
Age 3–14 years +１
Age 15–44 years 0
Age >44 years ) -1
Total score Risk of group A streptococcal infection (%)
4 点（51–53％） 3点（28–35％）2点（11–17％）1点（5–10％）0点（1-2.5%）
A群溶連菌の診断に対して咽頭培養は必要か？
Is throat culture considered a necessary clinical instrument for diagnosis of group A streptococci?
→ルーチンでは必要ない（時間がかかるため）
Throat culture is not necessary for routine diagnosis of acute sore throat to detect group A streptococci (C-3).
A群溶連菌に対する妥当性があり、正確な診断検査は？ RAT陰性後咽頭培養を行う必要があるか？
What is the validity and accuracy of near patient diagnostic tests for group A streptococcus? Is it necessary to perform a throat culture after a negative RAT for the diagnosis of group A streptococci?
→RATが陰性であれば必要ない。
If RAT is performed, throat culture is not necessary after a negative RAT for the diagnosis of group A streptococci in both children and adults (B-2).
RAT 感度86-94.8% 特異度95% (採取手技により影響を受ける)
posterior pharyngeal wall and both tonsilから採取
A群溶連菌に対する高い臨床スコアではRATの診断価値があがるか？
Is the diagnostic value of RAT increased when tests are performed in subjects with high clinical scores for group A streptococci, i.e. indicators that increase the likelihood of strep throat, as Centor score or modified Centor score?
→上昇する。
In patients with a high likelihood of streptococcal infections (e.g. 3–4 Centor criteria) physicians can consider the use of RATs. In patients with lower likelihood of streptococcal infections (e.g. 0–2 Centor criteria) there is no need to routinely use RATs (B-3).
急性咽頭痛の重症度アセスメントでCRP, プロカルシトニンの役割は？
Is there role for additional tests (e.g. C-reactive protein, procalcitonin measurements) in the assessment of severity of acute sore throat? Does clinical information combined with biomarker information provide better prognostic information?
→必要ない。
It is not necessary, based on current evidence, to routinely
use biomarkers in the assessment of acute sore throat (C-3).
診断テストは抗菌薬使用を改善させるか？
Does improved diagnosis or the use of near patient tests improve
antibiotic use？
→有用である。Clinical scoring systems and rapid tests can be helpful in targeting antibiotic use (B-2).
鎮痛薬は咽頭痛に有効か？
Are analgesics effective in sore throat?
→推奨される。
Either ibuprofen or paracetamol are recommended for relief of acute sore throat symptoms (A-1).
咽頭痛での副腎皮質ステロイドの使用指針は？
What are the indications for use of glucocorticoids in sore throat?
→ルーチンでは推奨されないが、成人で症状が強い場合には考慮される。
Use of corticosteroids in conjunction with antibiotic therapy is not routinely recommended for treatment of sore throat. It can, however, be considered in adult patients with severe presentations, e.g. 3–4 Centor criteria (A-1).
Zinc gluconateの使用指針は？
What are the indications for use of zinc gluconate in the treatment of sore throat?
→推奨されない。
Zinc gluconate is not recommended to be used in the treatment of sore throat (B-2).
Complementary treatmentsの指針は？
What are the indications for complementary treatments, e.g. herbal treatments or acupuncture in sore throat？
→一致したデータなし。There is inconsistent evidence of herbal treatments and acupuncture as treatments for sore throat (C-1 to C-3).
抗菌薬治療の平均効果と抗菌薬治療の恩恵を受けるグループは？
What is the average benefit from antibiotics and which groups of patients benefit from antibiotic treatment?
→low riskでは推奨されない。通常の大部分では抗菌薬治療は必要なし。
Sore throat should not be treated with antibiotics to prevent the development of rheumatic fever and acute glomerulonephritis in low-risk patients (A-1). The prevention of suppurative complications is not a specific indication for
antibiotic therapy in sore throat (A-1). Clinicians do not need to treat most cases of acute sore throat to prevent quinsy, acute otitis media, cervical lymphadenitis, mastoiditis or acute sinusitis (A-3).
抗菌薬は咽頭痛の症状を改善させるか？
Do antibiotics relieve symptoms in sore throat?
→使用するならばpenicillin V 2回又は3回 10日間。治療期間短縮のエビデンスはない。
If antibiotics are indicated, penicillin V, twice or three times daily for 10 days, is recommended (A-1). There is not enough evidence that indicates shorter treatment
Length
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