Published online June 1, 2006
PEDIATRICS Vol. 117 No. 6 June 2006, pp. 1871-1878 (doi:10.1542/peds.2005-2323)

This Article Full Text Full Text (PDF) Submit a response View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (8) Citing Articles via Google Scholar Google Scholar Articles by Park, S. Y. Articles by Besser, R. E. Search for Related Content PubMed PubMed Citation Articles by Park, S. Y. Articles by Besser, R. E. Related Collections Infectious Disease & Immunity Social Bookmarking                         What's this?

Clinicians' Management of Children and Adolescents With Acute Pharyngitis

Sarah Y. Park, MD^a,b,,c, Michael A. Gerber, MD^d, Robert R. Tanz, MD^e, John M. Hickner, MD, MSc^f,g, James M. Galliher, PhD^g,h, Ilin Chuang, MD, MPH^b,i and Richard E. Besser, MD^b

^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.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				R. R. Tanz, M. A. Gerber, W. Kabat, J. Rippe, R. Seshadri, and S. T. Shulman Performance of a Rapid Antigen-Detection Test and Throat Culture in Community Pediatric Offices: Implications for Management of Pharyngitis Pediatrics, February 1, 2009; 123(2): 437 - 444. [Abstract] [Full Text] [PDF]

				J. D. Woodburn, K. L. Smith, and G. D. Nelson Quality of Care in the Retail Health Care Setting Using National Clinical Guidelines for Acute Pharyngitis American Journal of Medical Quality, December 1, 2007; 22(6): 457 - 462. [Abstract] [PDF]

				M. D. Cabana, H. Abu-Isa, S. M. Thyne, and B. Yawn Specialty Differences in Prescribing Inhaled Corticosteroids for Children Clinical Pediatrics, October 1, 2007; 46(8): 698 - 705. [Abstract] [PDF]

				G. Worrall, J. Hutchinson, G. Sherman, and J. Griffiths Diagnosing streptococcal sore throat in adults: Randomized controlled trial of in-office aids Can Fam Physician, April 1, 2007; 53(4): 666 - 671. [Abstract] [Full Text] [PDF]

				A. L. Bisno, M. A. Gerber, and E. L. Kaplan Treatment of adults with acute pharyngitis in primary care practice. Arch Intern Med, November 13, 2006; 166(20): 2291 - 2291. [Full Text] [PDF]

eLetters:

Read all eLetters

Throat cultures and CLIA

Leonard Levy, MD, FAAP

Pediatrics Online, 3 Jun 2006 [Full text]

pharyngitis revisited

Santosh V Kondekar, et al.

Pediatrics Online, 4 Jul 2006 [Full text]