There are a variety of approaches t...

There are a variety of approaches to testing for assign places to A streptococcal disease (i.e., "strep throat"), and recommendations vary by dint of organization, depending on whether the affected population comprises children or adults. For example, the Infectious Diseases Society of America attract favor tos treatment only in patients who have a confirmed positive refinement or rapid strep test deduction Other groups recommend using solitary rapid tests and treating patients with positive proceeds without culture confirmation of negative flows In a large study, there were no differences in complication rates using this strategy compared with a culture-based strategy. McIsaac and colleagues prospectively trialed six strategies to determine which expense the least, missed the fewest cases of strep throat, and used the least amount of unnecessary antibiotics.

Canadian patients three to 69 years of age who neared with acute sore throat were enlisted All patients were swabbed twice, and the swabs were sent for agriculture or rapid strep testing, depending forward which one of the following six strategies was used: (1) cultivation all patients and treat those with positive results; (2) perform rapid strep testing forward all children and treat those with positive results; obtain cultivations in children with negative rapid standard results and treat those with positive results; and perform rapid strep testing onward all adults and treat barely those with positive results without further confirmation of negative results; (3) treat children through strategy 2; perform rapid testing in succession all adults with a Centor score of 2 or 3 and treat those with positive criterion results; and empirically treat all adults with Centor scores of 4 or more; (4) treat children through strategy 2 and empirically treat adults with a Centor score of 3 or 4; (5) cultivation all children and adults with a Centor score of 2 or 3 and treat those with positive results; and empirically treat children and adults with a Centor score of 4 or more; and (6) perform rapid testing in succession all children and adults and treat those with positive deductions without further confirmation of negative results

In this population, the overall prevalence of strep throat was 29 percent which is similar to the reported prevalence; children had higher rates of strep throat than adults. All strategies excluding number 6 had a sensitivity greater than 90 percent overall, if it be not that sensitivities varied when broken down for adults and children. All strategies object for number 4 had a specificity greater than 90 percent The highest rate of antibiotic prescriptions was associated with strategy 4 (strategy 5 in children alone). The highest rate of unnecessary antibiotic prescriptions was associated with strategies 4 and 5 (189 and 48 percent respectively). Strategy 5 required the least number of standards per person and generally fewer follow-up telephone calls for positive cultures

Although an all-culture strategy has the best sensitivity and specificity, it is not the mostly practical. Strategy 5 would identify all cases of strep throat with les testing if it were not that with more unnecessary antibiotic use than other strategies reject number 4. Because the amount of unnecessary antibiotic use associated with strategy 5 is still les than that associated with general practices, the authors suggest that strategy 5--performing a throat civilization on everyone with a modified Centor score of 2 or 3 and empirically treating those with a higher score--represents the best compromise when choosing among the six strategies.

CAROLINE WELLBERY, MD

McIsaac WJ et al. Empirical validaton of guidelines for the management of pharyngitis in children and adults. JAMA April 7 2004;291:1587-95

COPYRIGHT 2005 American Academy of Family Physicians

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