Home LiteratureArticle Details
PMID: 9116521 Published · ppublish English Journal Article Research Support, Non-U.S. Gov't Review

Reconsidering sore throats. Part 2: Alternative approach and practical office tool.

Canadian family physician Medecin de famille canadien ·Vol. 43 ·1997-03-00 ·Pages 495-500

McIsaac WJ, Goel V, Slaughter PM, Parsons GW, Woolnough KV, Weir PT, Ennet JR

Abstract

To identify a management approach for Group A streptococcal (GAS) pharyngitis that would address overuse of antibiotics and could be implemented immediately. 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. 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. 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.

MeSH Terms
Decision Support Techniques Diagnosis, Differential Discriminant Analysis Family Practice Humans Office Visits Pharyngitis/diagnosis,drug therapy Reproducibility of Results Sensitivity and Specificity Severity of Illness Index Streptococcal Infections/diagnosis,drug therapy Streptococcus pyogenes
Authors & Affiliations
7 authors, click to expand affiliations / ORCID
McIsaac W J
Institute for Clinical Evaluative Sciences, North York, Ont. [email protected]
Goel V
Slaughter P M
Parsons G W
Woolnough K V
Weir P T
Ennet J R
References (33)
33 references, click to expand
  1. Applicability of a scoring system in the diagnosis of streptococcal pharyngitis.
    Clin Pediatr (Phila). 1983 Sep;22(9):622-6 PMID: 6883893
  2. Transportability of a decision rule for the diagnosis of streptococcal pharyngitis.
    Arch Intern Med. 1986 Jan;146(1):81-3 PMID: 3510600
  3. The effect of parental expectations on treatment of children with a cough: a report from ASPN.
    J Fam Pract. 1993 Jul;37(1):23-7 PMID: 8345335
  4. Guidelines for the selective use of throat cultures in the diagnosis of streptococcal respiratory infection.
    Pediatrics. 1971 Oct;48(4):573-82 PMID: 5114745
  5. Penicillin failure and copathogenicity in streptococcal pharyngotonsillitis.
    J Fam Pract. 1994 Feb;38(2):175-9 PMID: 8308510
  6. The prediction of streptococcal pharyngitis in adults.
    J Gen Intern Med. 1986 Jan-Feb;1(1):1-7 PMID: 3534166
  7. Rational decision making based on history: adult sore throats.
    J Gen Intern Med. 1988 May-Jun;3(3):213-7 PMID: 3288726
  8. Compliance with short-term antimicrobial therapy: some techniques that help.
    Pediatrics. 1976 Mar;57(3):383-6 PMID: 1256949
  9. Diagnosis, antibiotic treatment and outcome of acute tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries.
    Fam Pract. 1992 Sep;9(3):255-62 PMID: 1459378
  10. Why do patients consult the general practitioner? Determinants of their decision.
    Br J Gen Pract. 1992 Aug;42(361):313-6 PMID: 1457150
  11. Prevention of rheumatic fever. A statement for health professionals by the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, the American Heart Association.
    Circulation. 1988 Oct;78(4):1082-6 PMID: 3139324
  12. Physician response to a prediction rule for the triage of emergency department patients with chest pain.
    J Gen Intern Med. 1994 May;9(5):241-7 PMID: 8046525
  13. Changing epidemiology of group A streptococcal infection in the USA.
    Lancet. 1990 Nov 10;336(8724):1167-71 PMID: 1978035
  14. Reconsidering sore throats. Part I: Problems with current clinical practice.
    Can Fam Physician. 1997 Mar;43:485-93 PMID: 9116520
  15. Recognition of streptococcal pharyngitis in adults.
    Arch Intern Med. 1975 Nov;135(11):1493-7 PMID: 1103766
  16. Clinical and microbiological evidence for endemic pharyngitis among adults due to group C streptococci.
    Arch Intern Med. 1990 Apr;150(4):825-9 PMID: 2327842
  17. Selective utilization of clinical diagnosis in treatment of pharyngitis.
    J Fam Pract. 1975 Jun;2(3):173-7 PMID: 1097578
  18. Factors influencing antibiotic use in acute respiratory tract infections in family practice.
    Can Fam Physician. 1988 Oct;34:2149-52 PMID: 21253243
  19. Selective testing for streptococcal pharyngitis in adults.
    J Fam Pract. 1987 Oct;25(4):347-53 PMID: 3116151
  20. The comparative cost-effectiveness of statistical decision rules and experienced physicians in pharyngitis management.
    JAMA. 1986 Dec 26;256(24):3353-7 PMID: 3097339
  21. The prevalence of Mycoplasma pneumoniae in ambulatory patients with nonstreptococcal sore throat.
    Fam Med. 1991 Feb;23(2):117-21 PMID: 1903744
  22. Sociocultural differences in patients' expectations at consultations for upper respiratory tract infection.
    J R Coll Gen Pract. 1987 May;37(298):205-6 PMID: 3694587
  23. The diagnosis of strep throat in adults in the emergency room.
    Med Decis Making. 1981;1(3):239-46 PMID: 6763125
  24. You can lead a horse to water--improving physicians' knowledge of probabilities may not affect their decisions.
    Med Decis Making. 1995 Jan-Mar;15(1):65-75 PMID: 7898300
  25. Bacteriology of the Upper Respiratory Tract: What is Important?
    Can Fam Physician. 1988 Oct;34:2155-9 PMID: 21253244
  26. Implementation of the Ottawa ankle rules.
    JAMA. 1994 Mar 16;271(11):827-32 PMID: 8114236
  27. An analysis of the cost-effectiveness of pharyngitis management and acute rheumatic fever prevention.
    Ann Intern Med. 1977 Apr;86(4):481-92 PMID: 403842
  28. Diagnosis of streptococcal pharyngitis: differentiation of active infection from the carrier state in the symptomatic child.
    J Infect Dis. 1971 May;123(5):490-501 PMID: 5115179
  29. The importance of disease prevalence in transporting clinical prediction rules. The case of streptococcal pharyngitis.
    Ann Intern Med. 1986 Oct;105(4):586-91 PMID: 3530079
  30. A simple scorecard for the tentative diagnosis of streptococcal pharyngitis.
    Am J Dis Child. 1977 May;131(5):514-7 PMID: 855837
  31. Assessment of clinical features predicting streptococcal pharyngitis.
    Scand J Infect Dis. 1993;25(2):177-83 PMID: 8511511
  32. Clinical scoring system in the evaluation of adult pharyngitis.
    Arch Otolaryngol Head Neck Surg. 1993 Mar;119(3):288-91 PMID: 8435167
  33. Determinants of non-compliance with short term antibiotic regimens.
    Br Med J (Clin Res Ed). 1987 Oct 3;295(6602):814-8 PMID: 3119056
Article Info
Journal
Canadian family physician Medecin de famille canadien
Abbr.
Can Fam Physician
ISSN
0008-350X
Email
[email protected]
Published
1997-03-00
Pages
495-500
Language
English
Region
Canada
NLM ID
0120300
PMCID
PMC2255308
Subset
IM
Corrections
CommentIn
PMID: 9154354
CommentIn
PMID: 9241452
External Links
PubMed source PMC Full Text View journal details
Analysis Services
Analysis Services

Contact

No. 2 Wenbo Road, Zhangqiu District, Jinan, Shandong

Qilu Normal University · Genelibs Bioinformatics Lab

750 Shunhua Rd, Jinan

2F, Bldg F, University Science Park

Tel: 0531-88819269

WeChat Official Account

Follow our WeChat subscription account for real-time updates and the latest in medical and biological research.


Business Email

E-mail: [email protected]

Copyright © 2026.Genelibs Jinan Honghui Biotechnology Co., Ltd. 鲁ICP备20007159号-2