الفهرس 
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Abstract
Recurrent pharyngitis represents a huge global health problem, if not treated; it causes much morbidity and mortality in children due to its serious complications. Recurrent pharyngitis is a very common complaint in the pediatric population and It is a persistent clinical problem that causes repeated use of antibiotics and a significant burden on both families (absences from school or work) and societies (health care costs). Thus, adequate preventive measures with the appropriate prophylactic antibiotic treatment have been sought for the management of the disease, as well as reducing its incidence.
Our study was designed to compare the effectiveness and safety of prophylactic treatment of oral amoxicillin, the long-standing recommended therapy of IM BPG, and tonsillectomy in reducing the episodes of recurrent pharyngitis. During study a throat swab was simultaneously obtained for standard throat culture from selected patients, in order to illustrate the distribution of the potentially pathogenic microorganisms causing recurrent pharyngitis.
The clinical criterion for study entry was three or more episodes of pharyngitis in six months. Patients were divided randomly into three groups A, B, and C. Group A received a monthly ten days course of a single daily dose of 25mg/kg/day of oral amoxicillin suspension (Delpedox 400mg/5ml; Deltapharma, Egypt) for six months, group B received (Retarpen 1.2 million units; Sandoz Pharma, Egypt) a single dose of intramuscularly administered benzathine penicillin G (IM BPG; 600 000 units if body weight <27 kg; 1.2 million units if body weight ≥27 kg) every 3 weeks for 6 months and group C included patients who undergo tonsillectomy.
The main findings of the present investigation can be summarized as follow:
1. The most predominant bacteria causing recurrent pharyngitis in the study patients
When examining throat swab results of all study patient with recurrent pharyngitis, the most prevalent pathogenic bacterial species was Staphylococcus aureus. The next prevalent pathogenic organism was GAS.
2. The significant of recurrence of pharyngitis before and after oral administration of amoxicillin in group A (n = 30), IM injection of penicillin in group B (n = 30), and tonsillectomy patients in group C (n = 20).
A highly statistically significant improvement in mean SD recurrence of pharyngitis was observed post treatment for groups A, B and C.
Similarly, the mean SD absence of children from school showed a marked significant decrease post treatment for groups A, B and C.
3. Comparison of recurrence and school absence following oral administration of amoxicillin in group A (n = 30), IM injection of penicillin in group B (n = 30), and tonsillectomy patients in group C (n = 20).
The six months treatment period of a monthly ten days course of oral amoxicillin (25mg/kg/day) were comparable to IM penicillin treatment every 3 weeks regarding recurrence and school absence. There is no significant difference between group A receiving oral amoxicillin and group B receiving IM penicillin.
However, regarding the tonsillectomy patients group, the mean SD recurrence and school absence was significantly decreased when compared to the oral treatment group. On the other hand, no significant difference was observed between the parenteral therapy group and the tonsillectomy patients group.
4. The effect of different parameters on recurrent pharyngitis
The incidence of recurrent pharyngitis was not significantly changed with either the sex or vaginal delivery or family history or the presence of joint pain however the breast fed study patient were found to significantly decrease recurrence compared to non-breast fed ones. Also we found that there is no relation between joint pain and the swab (either positive or negative) or the type of bacteria
5. Adverse effects
All treatments were well tolerated. Minor side effects were reported by in the oral amoxicillin group including; mouth ulcers and stomach pain. In the IM PBG reported discomfort at the site of injection.
6. Compliance
There was no significant difference between the oral and parenteral treatment groups.
Depending on the previous findings, it could be concluded that:
The once daily oral amoxicillin was a safe, effective and convenient alternative to IM penicillin in reducing recurrences and school absence provided that proper compliance is stressed. Thus it is more preferable to avoid the painful and psychic impact on children from IM PBG unless compliance is an issue.
In contrast to amoxicillin, intramuscular penicillin was a convenient alternative to tonsillectomy in reducing recurrences and school absence. Moreover, tonsillectomy is a suitable alternative to antimicrobial treatment; however it should be reserved for severe cases not responding to treatment due to its related morbidity and possible complications.