For patients with penicillin allergy, we can use erythromycin for 10 days, or azithromycin for 5 days6. S. pyogenes strains are quick to develop macrolide resistance, and the literature does not recommend azithromycin as first treatment option4. Sulfonamides and tetracyclines are not indicated to treat streptococcal pharyngotonsillitis because of the high rate of failure in bacterial eradication.
Thanks to antibiotic treatment, fewer children are being submitted to tonsillectomy surgery because of repetitive bacterial pharyngotonsillitis. Surgery is indicated when the child has seven infectious episodes in one year, five episodes per year in two years or 3 episodes per year in three consecutive years.
Rheumatic fever is the main cause of chronic acquired cardiopathy in children and adolescents in our country8. The disease diagnosis is performed according to Jones's criteria, established by the American Heart Association and revised in 1992. The presence of two major criteria or one major and two minor, associated with proof of previous streptococcal infection is highly suggestive of rheumatic fever (Table 1). Chorea is the only criterion that, alone, is diagnostic of the disease8. High titers of ASLO only indicate a recent infection by S. pyogenes, however, alone, it does not establish the diagnosis of acute rheumatic fever, nor measure disease activity.
The goal of the present investigation was to study the opinions and treatment approaches of pediatricians, and otorhinolaryngologists from the State of São Paulo in terms of diagnosis, treatment and prevention of pharyngotonsillitis and its complications in children.