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Study Evaluates Various Strategies for Diagnosis and Treatment of Sore Throat

CHICAGO - A comparison of various guidelines and strategies for treatment of sore throat provides information that may help optimize use of diagnostic tests and reduce unnecessary use of antibiotics, according to a study in the April 7 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, recent guidelines for management of a sore throat (pharyngitis) vary in their recommendations concerning antibiotic treatment and the need for laboratory confirmation of group A streptococcus (GAS, "strep throat"). An estimated 6.7 million health care visits are made by adults with a sore throat in the United States annually; between 1989 and 1999, 70 percent of adults presenting with sore throat received an antibiotic prescription.

Warren McIsaac, M.D., M.Sc., of Mount Sinai Hospital, Toronto, Ontario, and colleagues conducted a study to assess the impact of different clinical guidelines on the appropriateness of antibiotics prescribed, the proportion of GAS sore throat cases identified, and the use of throat cultures and rapid tests to detect GAS in a population of children and adults with a chief complaint of a sore throat.

Throat cultures and rapid antigen tests were obtained from 787 children and adults aged 3 to 69 years with acute sore throat attending a family medicine clinic in Calgary, Alberta, from September 1999 to August 2002.

Recommendations from 2 guidelines (those of the Infectious Diseases Society of America [IDSA], and the American College of Physicians-American Society of Internal Medicine/American Academy of Family Physicians/U.S. Centers for Disease Control and Prevention [ASIM]) were compared with rapid testing alone, a clinical prediction rule (a clinical measurement called a Centor score), and a standard of treatment for positive throat culture results only.

The researchers found that "the selective use of throat cultures as advocated in guidelines for the management of pharyngitis is compatible with a goal of reducing overall and unnecessary use of antibiotics for treatment of pharyngitis. However, empirical antibiotic treatment of adults with a Centor score of 3 or greater as proposed in the ASIM guideline may result in 40 percent of adults being prescribed antibiotics unnecessarily. Throat cultures, or throat culture confirmation of negative rapid test results, continue to be necessary in children to ensure optimal identification of GAS pharyngitis," the authors write.

(JAMA. 2004;291:1587-1595. Available post-embargo at JAMA.com)
Editor's Note: This study was funded by Abbott Laboratories, Montreal, Quebec.

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