Abstract
BackgroundThe role of non-group A streptococci and Fusobacterium necrophorum in pharyngotonsillitis has been disputed and few prospective studies have evaluated the effect of antibiotic treatment. This study uses registry data to investigate the relation between antibiotic prescription for pharyngotonsillitis in primary healthcare and return visits for pharyngotonsillitis, complications, and tonsillectomy.MethodsRetrospective data were extracted from the regional electronic medical record system in Kronoberg County, Sweden, for all patients diagnosed with pharyngotonsillitis between 2012 and 2016. From these data, two cohorts were formed: one based on rapid antigen detection tests (RADT) for group A streptococci (GAS) and one based on routine throat cultures for β-haemolytic streptococci and F. necrophorum. The 90 days following the inclusion visit were assessed for new visits for pharyngotonsillitis, complications, and tonsillectomy, and related to bacterial aetiology and antibiotic prescriptions given at inclusion.ResultsIn the RADT cohort (n = 13,781), antibiotic prescription for patients with a positive RADT for GAS was associated with fewer return visits for pharyngotonsillitis within 30 days compared with no prescription (8.7% vs. 12%; p = 0.02), but not with the complication rate within 30 days (1.5% vs. 1.8%; p = 0.7) or with the tonsillectomy rate within 90 days (0.27% vs. 0.26%; p = 1). In contrast, antibiotic prescription for patients with a negative RADT was associated with more return visits for pharyngotonsillitis within 30 days (9.7% vs. 7.0%; p = 0.01). In the culture cohort (n = 1 370), antibiotic prescription for patients with Streptococcus dysgalactiae ssp. equisimilis was associated with fewer return visits for pharyngotonsillitis within 30 days compared with no prescription (15% vs. 29%; p = 0.03).ConclusionsAntibiotic prescription was associated with fewer return visits for pharyngotonsillitis in patients with a positive RADT for GAS but with more return visits in patients with a negative RADT for GAS. There were no differences in purulent complications related to antibiotic prescription.
Highlights
The role of non-group A streptococci and Fusobacterium necrophorum in pharyngotonsillitis has been disputed and few prospective studies have evaluated the effect of antibiotic treatment
Antibiotic type was not associated with the outcomes. In this registry-based study of patients diagnosed with pharyngotonsillitis at a visit in primary healthcare, antibiotic prescription was associated with a lower proportion of return visits for pharyngotonsillitis in patients with a positive Rapid Antigen Detection Test (RADT) for group A streptococci (GAS) but with a higher proportion of return visits in patients with a negative RADT for GAS
As no randomised controlled trial has been sufficiently sized to study the effect of antibiotics on nongroup A streptococci and F. necrophorum in patients with pharyngotonsillitis, this study offers valuable observational data
Summary
The role of non-group A streptococci and Fusobacterium necrophorum in pharyngotonsillitis has been disputed and few prospective studies have evaluated the effect of antibiotic treatment. Infectious pharyngotonsillitis can be caused by a wide array of viruses and bacteria, of which Streptococcus pyogenes (group A streptococci, GAS) is the most important pathogen and the only one that warrants antibiotic treatment according to most guidelines [1,2,3,4]. The Sore Throat Guideline Group within the European Society for Clinical Microbiology and Infectious Diseases advocates using the Centor scoring system (one point each for fever, cervical lymphadenitis, tonsillar coating, and absence of cough) [6] to select patients with a higher likelihood of GAS infection (i.e., 3–4 criteria) and considering using a Rapid Antigen Detection Test (RADT) for these patients [3]. The Swedish Medical Products Agency has adopted this guideline for the most part but stresses that an RADT should only be performed in patients with Centor scores 3–4 as these are the patients who could benefit from antibiotic treatment [1]
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