Abstract
BackgroundGroup A streptococcus (GAS) is the most common bacterial etiology of pharyngitis but is difficult to distinguish clinically from viral pharyngitis. There are benefits to early antibacterial treatment of GAS pharyngitis, but administering antibiotics to children with viral pharyngitis is ineffective and costly. We evaluated adherence to guidelines that were developed to help clinicians distinguish between viral and GAS pharyngitis and guide management.MethodsRetrospective cohort study of patients ages 3–18 who had a rapid streptococcal test and/or throat culture performed in an outpatient setting. We collected data on documentation of components of the McIsaac score and classified tests as indicated if the score was ≥2. Based on McIsaac score and GAS test results, we determined whether each antibiotic course prescribed was indicated according to the Infectious Diseases Society of America guideline.ResultsAmong 291 eligible children, 87 (30%) had all five components of the McIsaac score documented. There was sufficient data to classify the score as either < 2 or ≥2 in 234 (80%); among these, 96% of tests were indicated. Twenty-nine patients (10%) were prescribed antibiotics. Eight (28%) of these prescriptions were not indicated according to guidelines.ConclusionsThe majority of GAS tests in children with pharyngitis are indicated, although providers do not regularly document all elements of a validated pharyngitis scoring tool. Over one quarter of children prescribed antibiotics for pharyngitis did not require antibiotics according to guidelines. There remains a role for targeted antimicrobial stewardship education regarding pharyngitis management in pediatric outpatient settings.
Highlights
Group A streptococcus (GAS) is the most common bacterial etiology of pharyngitis but is difficult to distinguish clinically from viral pharyngitis
Brennan-Krohn et al BMC Pediatrics (2018) 18:43 pharyngitis recommends that patients whose clinical presentation is consistent with GAS pharyngitis be tested with a streptococcal rapid antigen detection test (RADT) or throat culture; treatment is indicated if either is positive
Pharyngitis is an important target for antimicrobial stewardship efforts because of the large number of patients affected and because cases caused by GAS are difficult to distinguish clinically from those with a viral etiology [19]; such clinical uncertainty has been implicated in unnecessary antibiotic prescribing [20, 21]
Summary
Group A streptococcus (GAS) is the most common bacterial etiology of pharyngitis but is difficult to distinguish clinically from viral pharyngitis. We evaluated adherence to guidelines that were developed to help clinicians distinguish between viral and GAS pharyngitis and guide management. Brennan-Krohn et al BMC Pediatrics (2018) 18:43 pharyngitis recommends that patients whose clinical presentation is consistent with GAS pharyngitis be tested with a streptococcal rapid antigen detection test (RADT) or throat culture; treatment is indicated if either is positive. Studies evaluating the management of pharyngitis among pediatric providers have identified high rates of antibiotic prescribing [14], even for patients with negative GAS tests [15]. No study in a pediatric population has yet evaluated adherence to IDSA guidelines using individual patients’ clinical data and test results
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