RECURRENT STREPTOCOCCAL PHARYNGITIS - USING PRACTICAL TREATMENT OPTIONS TO INTERRUPT THE CYCLE

In reviewing diagnostic and therapeutic options for patients with grou p A beta-hemolytic streptococcal tonsillopharyngitis, primary care phy sicians should consider whether a single established protocol is appro priate for all cases in all practice settings. Treatment failures are expensive in terms of continued patient discomfort, potential complica tions, and possible contagion as well as time and costs for both patie nts and clinical staff. Noncompliance with prescribed therapy may be o ne of the most common reasons for treatment failures. Compliance in ca ses of acute conditions appears to correspond inversely to duration of treatment. Patients or parents who seem unlikely to comply with presc ribed therapy may benefit from education on the virulence of group A s treptococci, the danger of rheumatic fever, and tbe rationale for comp lying with the prescription. A simple technique is to remind them that if 99 of 100 bacteria are destroyed during treatment, the 1 that surv ives is the strongest; since bacteria multiply by division, the lone s urvivor may give rise to a new colony of ''super-bugs.'' A parenteral injection or an alternative short-course antibiotic may be in order fo r patients who are often noncompliant. Results of ongoing and recently completed studies suggest that new treatment regimens may bring bette r compliance and thus greater rates of bacteriologic eradication than currently available options. prevention of recurrence may actually off er an economic advantage over ostensibly less-expensive therapies.