Management of sore throat in Polish primary care facilities: an example from the country with rare use of microbiological testing

Abstract

To describe sore throat management by primary care physicians in Poland. We sent questionnaires to all primary care doctors in Podlaskie voievodship (north-eastern Poland) with clinical vignettes depicting patients with symptoms of sore throat. The probability of bacterial (streptococcal) infection was estimated using Centor's scale (assessment of four items--presence of tonsillar exudates, fever, lymphadenopathy and absence of cough--scores 0 and 1 indicate low probability of streptococcal infection). The respondents were asked for the suspected diagnosis (viral or bacterial pharyngitis), choose additional tests (if required to decide on management), and finally to decide on whether an antibiotic should be prescribed. Two-hundred and twenty-five of 610 doctors surveyed provided usefull answers. In cases with a very low probability of bacterial infection and a score of '0', antibiotics were prescribed by 1.8-43.7% of physicians. Only 1.8% would prescribe an antibiotic to an adult with a 1-day history of sore throat and a '0' score but as many as 43.7% when the patient consulted with the same symptoms and signs again (P < 0.05). Younger age of the patient was also significantly associated with higher rate of the antibiotic prescribing--7.6% would prescribe an antibiotic to a 5-year-old child with a '0' score while only 1.8% would prescribe an antibiotic for an adult with a similar score, P < 0.05. Primary care physicians in Poland tend to prescribe antibiotics for sore throats even for patients with a low risk of bacterial infection when influenced by factors like repeat visits of the patient or young age. Avoiding antibiotics in such low risk of bacterial infection patients is an important and achievable goal.