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Acute sore throat is a very common pathology, but should not because of this be considered as banal. In effect, the beta-haemolytic streptococcus A, which is responsible for most of the bacteriological etiologies is not only responsible for distant inflammatory complications, acute articular rheumatism (RAA) and glomerulonephritis, which are re-appearing in the United States, but also a fulminating septicemia and a syndrome of visceral failure that makes a grave prognosis for life. Moreover, today, streptococcus A is one of the factors involved in a series of fatal fasciites and necrosing myosites seen in several European countries. Understanding of these complications gives better definition of the causative immunological mechanisms and particularly the adverse role of the "superantigens" of streptococci in the start of an increase in the responses of immunocompetent cells and pro-inflammatory and prothrombic mediators. Finally, availability now of rapid diagnostic tests with monoclonal antibody techniques confirms the presence of streptococci A in acute sore throat and should help the physician to make an etiological diagnosis that takes into account the clinical signs. Unfortunately, these tests are not widely available in France and are not subject to reimbursement. All these factors justify the introduction of an antibiotherapy targetted at streptococcus A in the context of bacterial sore throat. Oral penicillin V (phenoxymethyl penicillin, Oracilline) is always the reference, with an excellent anti-bacterial and clinical activity and without risk of production of strains of streptococcus that are of reduced sensitivity or resistant.(ABSTRACT TRUNCATED AT 250 WORDS)

The choice of antibiotic therapy for sore throat of bacterial origin must be directed against the beta-haemolytic streptococcus A, or more rarely C and G. Recent bacteriological data confirm the raised and constant antibacterial activity in vitro of penicillins V and G, with minimal inhibitory concentrations (CMI) as low as 0.01 mg/ml. Until now, there have been no resistant or reduced sensitivity strains reported. Those strains reported as "tolerant" to penicillin are not correlated with therapeutic checks. As for strains of "intermediate sensitivity" to penicillin, these should be attributed to effects of the diffusion techniques. In contrast, in France now, 8% of strains of streptococcus A are resistant to macrolides and 60% to tetracyclines. Finally, new data show that the different selective powers of beta-lactamines, especially cephalosporins, introduce risks of modification of the oro-pharingeal ecology, linked in part with transfer of genetic material between commensal streptococci of reduced sensitivity to beta-lactamines to sensitive pneumococci. All these data emphasize the importance of an antibiotic therapy that is directed to streptococcus A, with a strong and constant bactericidal activity, without risk of selection or appearance of strains of resistant streptococcus A, and that will not disturb the long term bacterial ecology of the oro-pharynx. Now, in 1994 phenoxymethylpenicillin, Oracilline, penicillin V has the place of reference in the treatment of bacterial acute sore throat.

The beta-haemolytic streptococcus A, which is responsible for almost all bacterial sore throats in children and young adults, is the target for the first antibiotic treatment. What is really at stake for the treatment is to prevent the serious complications linked with this germ, acute articular rheumatism (RAA) and glomerulonephritis. The recurrence of RAA seen in the United States from 1985, has started many investigations as much for epidemiology as for therapy. Some authors have questioned the treatment with penicillin because of the rise in numbers of carriers of streptococcus A after treatment. They have suggested the use of compounds with a greater spectrum of activity. However, work in the international literature re-states the benefits of a targetted antibio-therapy in this context. Is it appropriate to use a wide spectrum antibiotic to treat an infection of monobacterial target, taking into account the bacteriological and clinical efficacy of penicillin, the only available treatment that has shown its capacity to prevent RAA, with a treatment length of 10 days and which seems to be constant with time? Because of this, faced with the ecological risks of a multi-use of wide range compounds, with a treatment that has not been validated in France, phenoxymethylpenicillin, Oracilline, penicillin V, the antibiotic targetted to sore throat and the streptococcal risk, is correct now for 1994.