Published online June 1, 2006
PEDIATRICS Vol. 117 No. 6 June 2006, pp. 1871-1878 (doi:10.1542/peds.2005-2323)
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Clinicians' Management of Children and Adolescents With Acute Pharyngitis

Sarah Y. Park, MDa,b,,c, Michael A. Gerber, MDd, Robert R. Tanz, MDe, John M. Hickner, MD, MScf,g, James M. Galliher, PhDg,h, Ilin Chuang, MD, MPHb,i and Richard E. Besser, MDb

a Epidemiology Program Office
b Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases
i Arizona Department of Health Services, Career Epidemiology Field Officer Program, National Center for Health Marketing, Centers for Disease Control and Prevention, Atlanta, Georgia
c Disease Outbreak Control Division, Hawaii Department of Health, Honolulu, Hawaii
d Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
e Children's Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, Illinois
f Department of Family Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois<, Chicago, Illinois
g American Academy of Family Physicians National Research Network, Leawood, Kansas
h Department of Sociology, University of Missouri, Kansas City, Missouri

OBJECTIVE. Sore throat is a common complaint in children and adolescents. With increasing antimicrobial resistance because of antimicrobial overuse, accurate diagnosis is imperative. Appropriate management of acute pharyngitis depends on proper use and interpretation of clinical findings, rapid antigen-detection tests, and throat cultures. We surveyed pediatricians and family physicians to evaluate their management strategies for children and adolescents with acute pharyngitis and to assess the availability and use of diagnostic tests in office practice.

METHODS. In 2004, surveys were mailed to a random sample of 1000 pediatrician members of the American Academy of Pediatrics and 1000 family physician members of the American Academy of Family Physicians. We assessed factors associated with physicians using an appropriate management strategy for treating acute pharyngitis.

RESULTS. Of 948 eligible responses, 42% of physicians would start antimicrobials before knowing diagnostic test results and continue them despite negative results, with 27% doing this often or always. When presented with clinical scenarios of patients with acute pharyngitis, ≤23% chose an empirical approach, 32% used an inappropriate strategy for a child with pharyngitis suggestive of group A Streptococcus, and 81% used an inappropriate strategy for a child with findings consistent with viral pharyngitis. Plating cultures in the office was associated with an appropriate management strategy, although not statistically significant. Solo/2-person practice and rural location were both independent factors predicting inappropriate strategies.

CONCLUSIONS. here is much room for improvement in the management of acute pharyngitis in children and adolescents. Most physicians use appropriate management strategies; however, a substantial number uses inappropriate ones, particularly for children with likely viral pharyngitis. Efforts to help physicians improve practices will need to be multifaceted and should include health policy and educational approaches.

Key Words: pharyngitis • Streptococcus group A • Streptococcus pyogenes • child • adolescent

Abbreviations: GAS—group A Streptococcus • RADT—rapid antigen-detection test • CLIA—Clinical Laboratory Improvement Amendments of 1988 • OR—odds ratio • CI—confidence interval

Accepted Nov 22, 2005.




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