Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Treatment of Adults With Acute Pharyngitis in Primary Care Practice

Treatment of Adults With Acute Pharyngitis in Primary Care Practice As members of the IDSA guideline committee on the management of GAS pharyngitis,1 we read with interest the article by Linder et al2 and editorial by Centor and Cohen3 regarding the management of adults with acute pharyngitis. As a point of clarification, we wish to point out that the article and editorial err in stating that the 4-point Centor criteria4 were explicitly recommended by the IDSA. We believe that clinical algorithms such as that of Centor et al4 can be most helpful in identifying patients whose risk of GAS pharyngitis is low enough to preclude the necessity of diagnostic testing. We do not, however, recommend their use in lieu of such testing in adult patients with sore throat, whose clinical findings are more highly suggestive of GAS infection. In this regard, we differ with the clinical practice guideline endorsed by the ACP.5 For example, Linder et al2 found that 60% of their patients meeting the 4 Centor criteria, who could be treated empirically according to the ACP guideline, nevertheless had negative rapid antigen detection test results and/or throat cultures for GAS. We were gratified to read the authors' conclusion that “perfect adherence to the IDSA strategy would result in the lowest rate of antibiotic prescribing.”2(p1378) Although we believe that the differences between the guidelines are more than “academic,” we concur strongly that the failure of primary care providers to follow any guideline is a more serious problem. To quote Linder et al, “interventions should focus on an area where the guidelines agree: avoiding testing and antibiotic prescribing to patients at low risk for streptococcal pharyngitis.”2(p1374) Not surprisingly, the problem is as serious, if not more so, in the pediatric population. As recently reported by one of us (M.A.G.),6 about 80% of pediatricians and family practitioners chose to perform a diagnostic test when presented with a case scenario of a child with pharyngitis whose clinical findings were highly suggestive of a viral infection. Our concerns about the ACP practice guideline should in no way overshadow the issues raised cogently by Linder et al2 and Centor and Cohen.3 Correspondence: Dr Bisno, Miami Veterans Affairs Medical Center, Medical Service (111), 1201 NW 16th St, Miami, FL 33125 (abisno@med.miami.edu). References 1. Bisno ALGerber MAGwaltney JM JrKaplan ELSchwartz RHInfectious Diseases Society of America, Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Clin Infect Dis 2002;35113- 125PubMedGoogle ScholarCrossref 2. Linder JAChan JCBates DW Evaluation and treatment of pharyngitis in primary care practice: the difference between guidelines is largely academic. Arch Intern Med 2006;1661374- 1379PubMedGoogle ScholarCrossref 3. Centor RMCohen SJ Pharyngitis management: focusing on where we agree. Arch Intern Med 2006;1661345- 1346PubMedGoogle ScholarCrossref 4. Centor RMWitherspoon JMDalton HPBrody CELink K The diagnosis of strep throat in adults in the emergency room. Med Decis Making 1981;1239- 246PubMedGoogle ScholarCrossref 5. Snow VMottur-Pilson CCooper RJHoffman JR Principles of appropriate antibiotic use of acute pharyngitis in adults. Ann Intern Med 2001;134506- 508PubMedGoogle ScholarCrossref 6. Park SYGerber MATanz RR et al. Clinicians' management of children and adolescents with acute pharyngitis. Pediatrics 2006;1171871- 1878PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Treatment of Adults With Acute Pharyngitis in Primary Care Practice

Loading next page...
 
/lp/american-medical-association/treatment-of-adults-with-acute-pharyngitis-in-primary-care-practice-042gGhw8NH
Publisher
American Medical Association
Copyright
Copyright © 2006 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.166.20.2291-b
Publisher site
See Article on Publisher Site

Abstract

As members of the IDSA guideline committee on the management of GAS pharyngitis,1 we read with interest the article by Linder et al2 and editorial by Centor and Cohen3 regarding the management of adults with acute pharyngitis. As a point of clarification, we wish to point out that the article and editorial err in stating that the 4-point Centor criteria4 were explicitly recommended by the IDSA. We believe that clinical algorithms such as that of Centor et al4 can be most helpful in identifying patients whose risk of GAS pharyngitis is low enough to preclude the necessity of diagnostic testing. We do not, however, recommend their use in lieu of such testing in adult patients with sore throat, whose clinical findings are more highly suggestive of GAS infection. In this regard, we differ with the clinical practice guideline endorsed by the ACP.5 For example, Linder et al2 found that 60% of their patients meeting the 4 Centor criteria, who could be treated empirically according to the ACP guideline, nevertheless had negative rapid antigen detection test results and/or throat cultures for GAS. We were gratified to read the authors' conclusion that “perfect adherence to the IDSA strategy would result in the lowest rate of antibiotic prescribing.”2(p1378) Although we believe that the differences between the guidelines are more than “academic,” we concur strongly that the failure of primary care providers to follow any guideline is a more serious problem. To quote Linder et al, “interventions should focus on an area where the guidelines agree: avoiding testing and antibiotic prescribing to patients at low risk for streptococcal pharyngitis.”2(p1374) Not surprisingly, the problem is as serious, if not more so, in the pediatric population. As recently reported by one of us (M.A.G.),6 about 80% of pediatricians and family practitioners chose to perform a diagnostic test when presented with a case scenario of a child with pharyngitis whose clinical findings were highly suggestive of a viral infection. Our concerns about the ACP practice guideline should in no way overshadow the issues raised cogently by Linder et al2 and Centor and Cohen.3 Correspondence: Dr Bisno, Miami Veterans Affairs Medical Center, Medical Service (111), 1201 NW 16th St, Miami, FL 33125 (abisno@med.miami.edu). References 1. Bisno ALGerber MAGwaltney JM JrKaplan ELSchwartz RHInfectious Diseases Society of America, Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Clin Infect Dis 2002;35113- 125PubMedGoogle ScholarCrossref 2. Linder JAChan JCBates DW Evaluation and treatment of pharyngitis in primary care practice: the difference between guidelines is largely academic. Arch Intern Med 2006;1661374- 1379PubMedGoogle ScholarCrossref 3. Centor RMCohen SJ Pharyngitis management: focusing on where we agree. Arch Intern Med 2006;1661345- 1346PubMedGoogle ScholarCrossref 4. Centor RMWitherspoon JMDalton HPBrody CELink K The diagnosis of strep throat in adults in the emergency room. Med Decis Making 1981;1239- 246PubMedGoogle ScholarCrossref 5. Snow VMottur-Pilson CCooper RJHoffman JR Principles of appropriate antibiotic use of acute pharyngitis in adults. Ann Intern Med 2001;134506- 508PubMedGoogle ScholarCrossref 6. Park SYGerber MATanz RR et al. Clinicians' management of children and adolescents with acute pharyngitis. Pediatrics 2006;1171871- 1878PubMedGoogle ScholarCrossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 13, 2006

Keywords: primary health care,pharyngitis, bacterial, acute

References