Etiology of acute pharyngitis in children: is antibiotic therapy needed?

Hsin Chi, Nan-Chang Chiu, Wen-Chen Li, Fu-Yuan Huang
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan, ROC

Acute pharyngitis is a common upper respiratory tract disease in children. The aim of this study is to find the associated microorganisms and determinate whether antibiotics is needed. This study included a total of 416 children with a diagnosis of acute pharyngitis who were treated in an outpatient clinic In Taipei. Throat swabs for viral and bacterial cultures were taken. Antibiotics were prescribed when bacterial pharyngitis was suspected on the initial visit. The prescription was adjusted according to the results of bacterial culture and clinical manifestations on the second visit 3 to 4 days later. The mean age of the patients was 52.9 +/- 36.9 months. A total of 297 potential pathogens were isolated in 242 patients. Viruses were isolated in 123 (29.6%) patients. Bacteria were isolated in 73 (17.5%) patients, whereas group A streptococci were isolated in only 7 (1.7%) patients. Viruses mixed with bacteria were found in 46 (11.1%) patients. The mean age of patients with viral infections was lower than those with bacterial infections (47.5 +/- 30.4 vs 62.4 +/- 43.7 months, p = 0.01). There was a longer duration of fever in patients older than 2 years with viral isolates (p < 0.01). Antibiotics were prescribed for acute pharyngitis on the first visit in 43 (10.3%) patients, and on the second visit in 19 (4.6%) patients. In children with viral infection, mixed isolates, or no growth, there was significantly less prescription of antibiotics on the second visit. Given the low isolation rate of significant bacterial pathogens, routine throat cultures and antibiotics are not indicated in children with acute pharyngitis.

J Microbiol Immunol Infect 2003;36:26-30.