clump A beta-hemolytic streptococci...

clump A beta-hemolytic streptococci (GABHS) are set up in 15 to 36 percent of children presenting with sore throat. Numerous guidelines commend treating GABHS, only after testing, using penicillin as first-line treatment, with amoxicillin, erythromycin, and first-generation cephalosporins as second-line alternatives. Linder and colleagues analyzed data, focusing onward antibiotic prescribing rates based upon a chief complaint of sore throat and changes in exemplars of antibiotics prescribed as related to GABHS testing.

The authors used national ambulatory care statistics from 768553 patients seen in community, office-based physician practices, and hospital outpatient and juncture departments from 1995 to 2003 The investigation population included 4,158 children three to 17 years of age presenting with a chief complaint of sore throat and no other symptoms that could warrant an antibiotic prescription.

principally patients with a complaint of sore throat were diagnosed with acute pharyngitis (34 percent) streptococcus (17 percent) or upper respiratory tract infection (17 percent) More than united half of visits were to pediatricians, whereas the peace were to other primary care physicians and crisis departments. Antibiotics were prescribed in 53 percent of these visits. Of those antibiotics, 27 percent were not specifically commended for GABHS. Nonrecommended antibiotics included other cephalosporins, extendedspectrum macrolides, and amoxicillin/clavulanate (Augmentin). Antibiotic prescriptions decreased during the inquiry declining from 66 percent in 1995 to 44 percent in 2002 then increasing to 54 percent in 2003

There was a significant decrease in make acceptableed prescriptions, whereas the number of nonrecommended antibiotic prescriptions remained stable. A GABHS standard was performed in 53 percent of visits, a percentage that did not change throughout the study and resulted in an antibiotic prescription in 48 percent of cases. When no GABHS proof was performed, antibiotics were prescribed 51 percent of the time. Overall, GAHBS testing was not associated with antibiotic prescribing, unless when analyzed according to diagnostic digest there was less antibiotic prescribing in patients who had the GABHS standard than in those who did not. For example, when the visit digest was for acute pharyngitis, tonsillitis, or streptococcal sore throat, antibiotics were prescribed in 57 percent of visits where the GABHS standard was performed and in 73 percent of visits where it was not. This describes a 16 percent absolute reduction in the prescribing rate for this diagnostic code

This thought found that the prescribing rate for GABHS was higher than the look fored prevalence of this infection, and that in association with a certain quantity of diagnostic categories, antibiotics were prescribed les frequently when GABHS testing was performed. Inappropriate, broad-spectrum antibiotic use showed a turn toward increase even as the use of commended antibiotics declined. The study did not determine whether GABHS testing was indicated or not or whether the conclusions of the test were positive or negative. The authors bring to an end that correctly targeting a population for GABHS testing from age and symptoms, and treating and nothing else those with a positive inference using narrow-spectrum antibiotics, are important gradations towards judicious antibiotic use.

CAROLINE WELLBERY, MD

Linder JA, et al. Antibiotic treatment of children with sore throat. JAMA November 9 2005;294:2315-22

EDITOR'S NOTE: An older cogitation (1) examined six diagnostic approaches to adults and children with sore throat using rapid strep testing, refinement and scoring systems. The authors sought to determine the impact in succession cost, sensitivity and specificity, and antibiotic prescribing of each strategy. In seasons of the latter, all strategies directed at children leave out one (which was based forward performing a throat culture forward all patients below a certain cutoff score) originateed in low unnecessary antibiotic prescribing in children. These strategies included universal rapid strep testing with or without improvement confirmation of negative tests. Strategies targeting children had different impacts than those targeting adults.--C.W.

REFERENCE

(1) McIsaac WJ et al. Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA 2004;291:1587-95

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