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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar la fiabilidad y validez de un test r&#225;pido para la identificaci&#243;n de Streptococcus pyogenes en exudado far&#237;ngeode ni&#241;os con faringoamigdalitis aguda&#46; Evaluar el impacto de su aplicaci&#243;n ambulatoria sobre la utilizaci&#243;n de antibi&#243;ticos&#44; la incidencia de segundas visitas y complicacionesy el grado de satisfacci&#243;n de los usuarios</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Tras proceder al diagn&#243;stico cl&#237;nico de faringitis aguda&#44; informar a los padres y obtener su consentimiento escrito&#44;se realiz&#243; frotis faringoamigdalar con 2 torundas a 430 ni&#241;os atendidos en el servicio de urgencias de nuestro hospital o en las consultas de pediatr&#237;a de 3 centros de saludde la zona&#46; Con una muestra se efectu&#243; el test r&#225;pido QuickVue&#174; Flex Strep A&#44; envi&#225;ndose la otra al laboratorio para cultivo convencional&#46; Salvo excepciones&#44; se indic&#243; tratamiento antibi&#243;tico s&#243;lo si el test r&#225;pido era positivo&#44; haci&#233;ndose especial hincapi&#233; en explicar la ausencia de indicaci&#243;n de antibioterapia en el caso contrario&#46; Se proporcion&#243;seguimiento telef&#243;nico a los familiares durante 4 semanas&#44; pasando al final una encuesta de satisfacci&#243;n</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La sensibilidad del test r&#225;pido fue del 91&#44;2&#37; &#40;valor predictivonegativo 96&#44;5&#37;&#41; y la especificidad 96&#44;2&#37; &#40;valor predictivo positivo 90&#44;4&#37;&#41;&#46; Recibi&#243; tratamiento antibi&#243;ticoel 41&#44;9&#37; de los pacientes&#44; aproximadamente la mitad de lo esperado en ausencia del test r&#225;pido&#46; No se encontrarondiferencias significativas en el n&#250;mero de segundasvisitas ni de hospitalizaciones entre los grupos de tratados y no tratados&#46; La evoluci&#243;n cl&#237;nica fue favorable en todos los casos&#46; El grado de satisfacci&#243;n de los familiares result&#243; muy elevado entre los encuestados&#44; independientementede que el paciente hubiese recibido antibi&#243;tico o no</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El test r&#225;pido citado tiene una sensibilidad y especificidad adecuadas para orientar sin riesgos el tratamiento&#46; Es de f&#225;cil manejo y aplicaci&#243;n&#44; y su uso permite una disminuci&#243;n significativa del empleo de antibi&#243;ticos en esta patolog&#237;a&#46; La gran mayor&#237;a de usuarios acepta y est&#225; satisfecha con esta nueva aproximaci&#243;n diagn&#243;stico-terap&#233;utica</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To assess the reliability and validity of a rapid test for the identification of Streptococcus pyogenes in thepharyngeal exudate of children presenting with pharyngotonsillitis&#46; To evaluate the impact of its use in out patient clinics on antibiotic use&#44; on the incidence of second medical visits and complications&#44; and on the degree of parental satisfaction</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">After a clinical diagnosis of acute pharyngitis was establishedand written informed consent obtained from the parents&#44; dual throat swabs were collected from 430 children who attended the emergency department of our hospital or the pediatric offices of three health centers in our area&#46; The first specimen was examined by the rapid test&#44; QuickVue&#174; Flex Strep A&#44; and the second one was sent to the laboratory for conventional culture&#46; As a rule&#44; antibioticswere indicated only when the rapid test was positive&#46; Special emphasis was placed on explaining to parents that treatment was not necessary when the test was negative&#46; Telephone follow-up was provided to the family during the next four weeks&#44; after which a satisfaction survey was carried out</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The sensitivity of the investigated rapid test was 91&#46;2&#37;&#40;negative predictive value&#58; 96&#46;5&#37;&#41; and specificity was 96&#46;2&#37; &#40;positive predictive value&#58; 90&#46;4&#37;&#41;&#46; Antibiotics were given to 41&#46;9&#37; of the patients&#44; approximately half the expectedrate in the absence of the rapid test&#46; There was no significant difference in the number of second visits orhospitalizations between the groups of treated and non treated subjects&#46; Clinical evolution was good in all cases&#46; The degree of parental satisfaction was very high&#44; independent of the treatment given to the patients</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The rapid test for the detection of group A streptococciis a reliable tool for the selection of patients able to benefit from antibiotic treatment&#46; It is easy to handle and apply and its use allows a significant reduction in the administration of antibiotics in pharyngoton sill it is&#46; Mostusers accept and are satisfied with this novel diagnostic and therapeutic procedure</p>"
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Vol. 52. Núm. 3.
Páginas 212-219 (marzo 2000)
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Vol. 52. Núm. 3.
Páginas 212-219 (marzo 2000)
Acceso a texto completo
Empleo racional de los antibióticos en pediatría: impacto de la aplicación de un test rápido de detección de estreptococo beta-hemolítico del grupo A en la faringoamigdalitis aguda
Rational use of antibiotics in pediatrics: impact of a rapid test for detection of B-hemolytic group a streptococci in acute pharyngotonsillitis
Visitas
9312
C. Contessotto Spadettoa,
Autor para correspondencia
mai01mu@nacom.es

Correspondencia: C/Infanta Cristina, 5, 3B. 30007 Murcia
, M. Cámara Simónb, M.J. Avilés Inglésc, J.M. Ojeda Escurietd, I. Cascales Barcelóe, F. Rodríguez Sánchezf
a Servicios de Pediatría. Hospital Los Arcos. Santiago de la Ribera, Murcia
b Servicios de Microbiología. Hospital Los Arcos. Santiago de la Ribera, Murcia
c Servicios de Neumología. Hospital Los Arcos. Santiago de la Ribera, Murcia
d Centros de EAP: C.S. San Pedro del Pinatar. Murcia
e Centros de EAP: C.S. San Javier. Murcia
f Centros de EAP: C.S. Torre Pacheco. Murcia
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Estadísticas
Objetivos

Analizar la fiabilidad y validez de un test rápido para la identificación de Streptococcus pyogenes en exudado faríngeode niños con faringoamigdalitis aguda. Evaluar el impacto de su aplicación ambulatoria sobre la utilización de antibióticos, la incidencia de segundas visitas y complicacionesy el grado de satisfacción de los usuarios

Pacientes y métodos

Tras proceder al diagnóstico clínico de faringitis aguda, informar a los padres y obtener su consentimiento escrito,se realizó frotis faringoamigdalar con 2 torundas a 430 niños atendidos en el servicio de urgencias de nuestro hospital o en las consultas de pediatría de 3 centros de saludde la zona. Con una muestra se efectuó el test rápido QuickVue® Flex Strep A, enviándose la otra al laboratorio para cultivo convencional. Salvo excepciones, se indicó tratamiento antibiótico sólo si el test rápido era positivo, haciéndose especial hincapié en explicar la ausencia de indicación de antibioterapia en el caso contrario. Se proporcionóseguimiento telefónico a los familiares durante 4 semanas, pasando al final una encuesta de satisfacción

Resultados

La sensibilidad del test rápido fue del 91,2% (valor predictivonegativo 96,5%) y la especificidad 96,2% (valor predictivo positivo 90,4%). Recibió tratamiento antibióticoel 41,9% de los pacientes, aproximadamente la mitad de lo esperado en ausencia del test rápido. No se encontrarondiferencias significativas en el número de segundasvisitas ni de hospitalizaciones entre los grupos de tratados y no tratados. La evolución clínica fue favorable en todos los casos. El grado de satisfacción de los familiares resultó muy elevado entre los encuestados, independientementede que el paciente hubiese recibido antibiótico o no

Conclusiones

El test rápido citado tiene una sensibilidad y especificidad adecuadas para orientar sin riesgos el tratamiento. Es de fácil manejo y aplicación, y su uso permite una disminución significativa del empleo de antibióticos en esta patología. La gran mayoría de usuarios acepta y está satisfecha con esta nueva aproximación diagnóstico-terapéutica

Palabras clave:
Faringitis estreptocócica
Test rápido de detección de estreptococo grupo A
Uso racional de antibióticos
Niños
Objectives

To assess the reliability and validity of a rapid test for the identification of Streptococcus pyogenes in thepharyngeal exudate of children presenting with pharyngotonsillitis. To evaluate the impact of its use in out patient clinics on antibiotic use, on the incidence of second medical visits and complications, and on the degree of parental satisfaction

Patients and methods

After a clinical diagnosis of acute pharyngitis was establishedand written informed consent obtained from the parents, dual throat swabs were collected from 430 children who attended the emergency department of our hospital or the pediatric offices of three health centers in our area. The first specimen was examined by the rapid test, QuickVue® Flex Strep A, and the second one was sent to the laboratory for conventional culture. As a rule, antibioticswere indicated only when the rapid test was positive. Special emphasis was placed on explaining to parents that treatment was not necessary when the test was negative. Telephone follow-up was provided to the family during the next four weeks, after which a satisfaction survey was carried out

Results

The sensitivity of the investigated rapid test was 91.2%(negative predictive value: 96.5%) and specificity was 96.2% (positive predictive value: 90.4%). Antibiotics were given to 41.9% of the patients, approximately half the expectedrate in the absence of the rapid test. There was no significant difference in the number of second visits orhospitalizations between the groups of treated and non treated subjects. Clinical evolution was good in all cases. The degree of parental satisfaction was very high, independent of the treatment given to the patients

Conclusions

The rapid test for the detection of group A streptococciis a reliable tool for the selection of patients able to benefit from antibiotic treatment. It is easy to handle and apply and its use allows a significant reduction in the administration of antibiotics in pharyngoton sill it is. Mostusers accept and are satisfied with this novel diagnostic and therapeutic procedure

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