Pharyngitis
Ivelisse Ann Verrico, MD
Associate Program Director, Internal Medicine
Assistant Professor Internal Medicine/ Pediatrics
Studies in Primary Care settings show that approximately 70% patients with pharyngitis are prescribed antibiotics. Yet, the only commonly occurring cause of pharyngitis for which antibiotic therapy is indicated is Group A ß-hemolytic streptococci (GAS) which accounts for only 5-10% of total cases.
A recent study by Dalfino et.al., demonstrated that prescribing practices for pharyngitis in the ambulatory care setting do not meet current guidelines for GAS (Dalfino 2005). However, prelimnary results from a study by Alimohammad, Rhee, Verrico and Steinmann, suggest that educating prescribers in the ambulatory care setting, can improve antibiotic prescribing practices and adherence to current guidelines for GAS in pharyngitis
Differentiating GAS from other causes is difficult, but the Centor Criteria can assist in the diagnosis of pharyngitis.
Centor Criteria |
Points |
|---|---|
| 1. Tonsillar exudates | 1 |
| 2. Tender anterior cervical adenopathy | 1 |
| 3. Fever by history (>100.4) | 1 |
| 4. Absence of cough | 1 |
Treatment Recommendations per Infectious Diseases Society of America:
- <2 points: Do not test or treat, these patients are unlikely to have GAS infection
- For patients with two or more criteria the following options exist:
- >2-4 points: test patients by using a rapid antigen test (without follow-up culture in an adult); give antibiotics only to patients with positive test results
- >2-4 points: test patients by using a culture, and give antibiotics only to patients with positive test results
- 3-4 points: Empirically treat with antibiotics
68% of antibiotics prescribed for pharyngitis in primary care practices are more expensive and broader spectrum than recommended in practice guidelines. Current suggested antibiotic regimens are penicillin or erythromycin. These agents are shown to be efficacious, narrow spectrum, and have low cost.