Aim of the work -Assessing, on the basis a single paediatrician's experience, sensitivity and specificity of clinical diagnosis (intuitive, without explicit criteria) and probabilistic diagnosis (Breeze's score) of streptococcal pharyngitis; comparing the effectiveness of various treatment protocols.
Materials and methods - 70 children referred to for pharyngitis over the period November 1996 – March 1997 were recruited for this research. A rapid pharyngeal test (EVEN Strip STREP A from Boehringer) was carried out in all the cases. Before knowing the result, the paediatrician took note of his empirical decision (treatment vs. non-treatment) and collected all the elements for a Breeze's score. During the following year (September 1997 – March 1998), 60 children affected by tonsillopharyngitis and SBA positive were randomly administered one of the following therapeutic protocols: 

• group AM (20 children): Amoxicillin 75 mg/kg/die x 2 doses/day x 10 days; 
• group AZ (20 children): Azythromycin 10 mg/kg/die x 3 days; 
• group CF (20 children): Ceftibuten 9 mg/kg/die x 1 dose/day x 8 days. 

The assessment of the period of time required to get rid of fever, as well as the assessment of adverse effects, child compliance and clinical symptoms, were carried out by the families (questionnaire). Five days after treatment discontinuance, a second test was carried out.
Results - Neither empirical diagnosis nor Breeze's score-oriented diagnosis was sufficient to achieve or exclude, with an acceptable approximation, a SBA infection diagnosis (Table I). Patients affected by a test-proven streptococcal infection reacted - with one exception (almost certainly a healthy carrier) - in a similar way to the three treatment protocols. The number of positive cases at the end of the treatment was higher in the group AZ (Table II).
Conclusions - With a view to economy (AM), maybe compliance (CF) and resistance epidemiology, the use of beta-lactamines is recommended.