抗生素类
Family history of ARF
- Multiple documented GAS pharyngitis episodes within a family over several weeks despite therapy
If carriers are treated, clindamycin for 10 days or IM penicillin plus 4 days of rifampin are recommended treatment options. [39]
While some literature exists to support the use of a shorter course of antibiotic therapy for GAS pharyngitis, most international guidelines still recommend a 10-day course for most antibiotics. [40]
Penicillin G benzathine (Bicillin LA) 青霉素G苄星青霉素（Bicillin LA）
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Inhibits biosynthesis of cell wall mucopeptide. Bactericidal against sensitive organisms when adequate concentrations reached, and most effective during stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects. Still is drug of choice in GAS pharyngitis because of its narrow spectrum of activity, low cost, and proven safety track record. IM penicillin is drug of choice in patients where compliance is an issue because of single dose.
Penicillin VK (Beepen-VK) 青霉素VK
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Inhibits the biosynthesis of cell wall mucopeptide. Bactericidal against sensitive organisms when adequate concentrations are reached. Most effective during stage of active multiplication. Inadequate concentrations may produce only bacteriostatic effects. Poor patient compliance due to dosing frequency and duration plagues this drug regimen. However, tid dosing is shown in some studies to be as effective as qid dosing. For recurrent streptococcal infections, a combination of penicillin VK and rifampin may be used. Rifampicin, 20 mg/kg/d for 4 d, is added to the standard 10-d treatment with penicillin.
Amoxicillin (Amoxil, Biomox, Trimox) 阿莫西林
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Interferes with synthesis of cell wall mucopeptides during active multiplication resulting in bactericidal activity against susceptible bacteria. Associated with higher incidence of rash. No advantage over oral penicillin, but sometimes more acceptable to children because of taste. Some studies suggest that once-daily dosing of amoxicillin is adequate therapy for GABHS, but further studies are needed to validate this treatment regimen.
Cephalexin (Keflex) 头孢氨苄
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First-generation cephalosporin arrests bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal activity against rapidly growing organisms. Primary activity against skin flora. Used for skin infections or prophylaxis in minor procedures. Choice for patients who are sensitive for penicillin.
Azithromycin (Zithromax) 阿奇霉素
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This antibiotic has a higher cost but has a slightly higher effectiveness than erythromycin. Shorter course and one-a-day dosing make this a good alternative for patients who are allergic to penicillin.
Erythromycin (EES, Erythrocin, Ery-Tab) 红霉素
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Interferes with synthesis of cell wall mucopeptides during active multiplication resulting in bactericidal activity against susceptible bacteria (eg, M pneumoniae, C pneumoniae, A haemolyticus), which generally are not sensitive to penicillin. Indicated for patients allergic to penicillin. GABHS resistance is generally thought to be less than 5% in the United States, but more recent studies show resistance rates of up to 30%.
Clindamycin (Cleocin) 克林霉素
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Semisynthetic antibiotic produced by 7(S)-chloro-substitution of 7(R)-hydroxyl group of parent compound lincomycin. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Widely distributes in the body without penetration of CNS. Protein bound and excreted by the liver and kidneys.
Used for treatment of serious skin and soft tissue staphylococcal infections. Also effective against aerobic and anaerobic streptococci (except enterococci). More effective than penicillin in eliminating chronic streptococcal carriage. Recommended for treatment of symptomatic people with multiple, recurrent episodes of GABHS pharyngitis confirmed by rapid antigen testing or culture.
Ceftriaxone (Rocephin) 头孢曲松
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Third-generation cephalosporin with broad-spectrum gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins. Indicated for cases of gonococcal pharyngitis. Dosing is different for neonatal gonorrhea.
orticosteroids
Steroids have been shown to improve clinical symptoms in patients with pharyngitis, particularly in patients with severe or exudative pharyngitis. [41] Steroids are also used in cases of airway obstruction. They have been shown in several studies to reduce clinical symptoms and to shorten the clinical course. [42, 43] They should be used selectively for patients with significant swelling or odynophagia. [27, 43]
Dexamethasone (Decadron) 地塞米松
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Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability. For pharyngitis, steroids must be administered in conjunction with antibiotics. Provides symptomatic relief for severe pharyngitis. A one-time IM dose is convenient and avoids compliance issues. Betamethasone is an alternative to dexamethasone.
Prednisone (Deltasone, Orasone, Sterapred) 泼尼松
Antifungals
These agents are indicated for cases of pharyngitis associated with oral thrush.
Nystatin (Mycostatin)制霉菌素
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Fungicidal and fungistatic antibiotic obtained from Streptomyces noursei. Effective against various yeasts and yeastlike fungi. Changes permeability of fungal cell membrane after binding to cell membrane sterols, causing cellular contents to leak. Treatment should continue until 48 h after disappearance of symptoms.
Fluconazole (Diflucan)氟康唑
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Synthetic oral antifungal (broad-spectrum bistriazole) that selectively inhibits fungal CYP-450 and sterol C-14 alpha-demethylation. 广谱双三唑
总的来说，还是去看医生吧。 |
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