There is no doubt that the incidence of acute rheumatic fever (ARF) in North America and western Europe has plummeted over the course of the 20th century. The reasons for this decline are poorly understood but probably relate to a combination of factors, including improved socioeconomic conditions, widespread use of antibiotics in therapy for acute respiratory tract infections, and changes in the rheumatogenic potential of currently prevalent group A streptococcal strains.1 The decline in ARF does not, however, seem to be due to a disappearance of group A streptococci from the environment. The organism is readily isolated from the throats of a substantial minority of children initially seen with acute pharyngitis. Whatever the reasons, the incidence of ARF in certain parts of the United States has dropped as low as one case per 200,000 school-aged children per year.2
Currently accepted strategies for management of simple sore throat are
Bisno AL. Treating the Patient With Sore Throat Theory v Practice. JAMA. 1983;250(17):2351. doi:10.1001/jama.1983.03340170077036
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