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Clinicians' management of children and adolescents with acute pharyngitis
Sarah Y Park1, Michael A Gerber, Robert R Tanz
1Epidemiology Program Office, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, Georgia, USA. sarah.park@doh.hawaii.gov
Insights
Many physicians misuse antibiotics for pediatric sore throats, especially viral cases. Improving antibiotic stewardship requires multifaceted approaches, including education and policy changes, to combat antimicrobial resistance.
Area of Science:
- Pediatrics
- Infectious Diseases
- Antimicrobial Stewardship
Background:
- Sore throat is a frequent pediatric complaint.
- Antimicrobial resistance necessitates accurate diagnosis and appropriate management of acute pharyngitis.
- Current management relies on clinical findings and diagnostic tests like rapid antigen-detection tests and throat cultures.
Purpose of the Study:
- To survey pediatricians and family physicians on their management strategies for acute pharyngitis in children and adolescents.
- To assess the use and availability of diagnostic tests in office practices.
- To identify factors associated with appropriate management strategies.
Main Methods:
- A survey was mailed to 1000 pediatricians and 1000 family physicians in 2004.
- The survey assessed management strategies for acute pharyngitis and use of diagnostic tests.
- Factors associated with appropriate management were analyzed from 948 eligible responses.
Main Results:
- 42% of physicians initiated antimicrobials before diagnostic results, with 27% doing so often or always.
- Inappropriate strategies were used by 32% for suspected Group A Streptococcus and 81% for viral pharyngitis.
- Solo/2-person practices and rural locations predicted inappropriate strategies.
Conclusions:
- Significant improvement is needed in managing pediatric acute pharyngitis.
- While many physicians use appropriate strategies, a substantial number employs inappropriate ones, particularly for viral cases.
- Multifaceted efforts, including health policy and education, are required to enhance physician practices.
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, < or =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:
There 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.
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