How Connecticut primary care physicians view treatments for streptococcal and nonstreptococcal pharyngitis

Inappropriate antibiotic treatment of respiratory infections has been reported to be common; however, the specifics of this inappropriate treatment are not completely defined.

The aim of this study was to gather data to determine whether physicians consider the national guidelines of treating group A B-hemolytic streptococci (GABHS) pharyngitis with penicillin (BID or TID) and not using antibiotics to treat nonstreptococcal pharyngitis.

In this pilot survey, a 1-page questionnaire was sent to a random sample of Connecticut primary care physicians (PCPs) that included emergency physicians, family physicians, internists, and pediatricians. Two short hypothetical scenarios were presented: (1) an untreated male patient aged 18 years (who is not penicillin allergic) was seen the day before with fever and pharyngitis. He returns because he is still symptomatic and his throat culture (TC) is positive for GABHS; and (2) same scenario but this second patient's TC is negative for GABHS. Physicians were asked how they would treat the patients in both scenarios.

Of the 642 (representing approximately 15% of all Connecticut PCPs) questionnaires sent, 386 (60%) were returned. Seventy-five of the responding physicians had not seen patients with pharyngitis within the last year and were excluded; the following results were from 311 physicians. Scenario 1: 191 of 311 physicians (61%) indicated a willingness to treat the GABHS with penicillin. Pediatricians were significantly less likely, compared with the other PCPs, to prescribe penicillin (P = 0.01) in this scenario. Seventy-seven of the 191 physicians (40%) indicated a willingness to prescribe the penicillin QID. Seven PCPs who responded to scenario 1 did not respond to scenario 2. Scenario 2: 98 of the 304 physicians (32%) indicated a willingness to prescribe antibiotics for the patient with no: streptococcal pharyngitis. Pediatricians were significantly less likely, compared with the other PCPs, prescribe antibiotics for the patient with nonstreptococcal pharyngitis in the second scenario (P < 0.001).

This pilot survey found that 61% of Connecticut PCPs might treat GABHS with penicillin according to existing guidelines although the penicillin might be prescribed QID instead of the recommended BID or TID. Thirty-two percent of these PCPs reported they would use antibiotics to treat non-GABH pharyngitis.