ABSTRACT
OBJECTIVE: To provide evidence-based answers to clinical questions posed by family physicians about Group A streptococcus pharyngitis and to further understanding of why management is controversial. QUALITY OF EVIDENCE: Evidence from randomized trials was not found for most questions. The most critical information came from high-quality community prevalence studies and criterion standard studies of physician clinical judgement. MAIN FINDINGS: Expert recommendations for physician management are not likely to help prevent rheumatic fever, as most people with sore throats do not seek medical care. Current clinical practices result in overuse of antibiotics because accuracy of clinical judgment is limited. CONCLUSIONS: Costs associated with visits for upper respiratory infections as well as increasing antibiotic resistance necessitate reconsidering the current clinical approach. An alternative management strategy is presented in part 2.
Subject(s)
Pharyngitis/diagnosis , Pharyngitis/drug therapy , Practice Patterns, Physicians' , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcus pyogenes , Anti-Bacterial Agents/therapeutic use , Evidence-Based Medicine , Family Practice , Humans , Patient Acceptance of Health Care , Pharyngitis/complications , Rheumatic Fever/microbiology , Streptococcal Infections/complicationsABSTRACT
OBJECTIVE: To identify a management approach for Group A streptococcal (GAS) pharyngitis that would address overuse of antibiotics and could be implemented immediately. QUALITY OF EVIDENCE: No randomized, controlled trials were found; four observational studies met our criteria: simplicity, discrimination ability for GAS pharyngitis compared with throat culture, and validation in a different patient population. Only one scoring system fulfilled all three criteria. MAIN FINDINGS: Formal clinical scoring systems have the potential to improve family physicians' ability to identify and manage GAS pharyngitis. One system had been sufficiently validated to support its use in clinical practice. Four clinical characteristics (no cough, fever higher than 38 degrees C, exudate, and tender cervical nodes) linked to explicit management decisions form the basis for a sore throat score. CONCLUSIONS: Use of a clinical score for management of GAS pharyngitis can be recommended on the basis of the rarity of rheumatic fever in modern society, the resources devoted to management of upper respiratory tract illnesses, the volume of antibiotics prescribed, and the emergence of antibiotic resistance as a growing health issue.
