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Knowledge, Attitude, and Practice of House Officers to the Diagnosis and Management of Bacterial Pharyngitis: A
1Medicine, Alnau Teaching Hospital, Khartoum, SDN.
Insights
Pediatric house officers show poor-to-moderate knowledge in diagnosing and managing bacterial pharyngitis, with low adherence to first-line treatments like benzathine penicillin G. Fear of antibiotic resistance was noted as a positive behavior.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Practice Guidelines
- Medical Education
Background:
- Pharyngitis is a common pediatric clinical presentation.
- Prompt diagnosis of streptococcal pharyngitis is crucial to prevent severe complications like acute rheumatic fever.
- Early and accurate diagnosis is vital to avoid sequelae such as rheumatic heart disease.
Purpose of the Study:
- To assess the knowledge and practice of medical house officers regarding the diagnosis and management of bacterial pharyngitis.
- To identify gaps in understanding diagnostic criteria and appropriate antibiotic selection for streptococcal pharyngitis.
- To evaluate adherence to recommended treatment protocols for bacterial pharyngitis.
Main Methods:
- A cross-sectional, multicenter study involving 135 medical house officers in Khartoum.
- Data collected through surveys on knowledge of Group A beta-hemolytic streptococcus (GAS) pharyngitis criteria and management.
- Assessment of laboratory test utilization and prescribed medications for bacterial pharyngitis.
Main Results:
- Most house officers reported moderate knowledge (68.9%) but poor practice regarding bacterial pharyngitis diagnosis and management.
- Key diagnostic criteria like absence of cough and recognition of benzathine penicillin G as first-line treatment were poorly understood.
- Amoxicillin-clavulanic acid was frequently prescribed, and adherence to benzathine penicillin G was low (20.7%).
Conclusions:
- Medical house officers exhibit significant deficiencies in knowledge and practice concerning bacterial pharyngitis, particularly in antibiotic choice.
- Poor knowledge correlated with poor practice, while frequent case exposure was linked to better knowledge.
- Despite knowledge gaps, a fear of antibiotic resistance suggests a potential for improved practice with targeted education.
Background:
Pharyngitis is one of the most common clinical presentations in pediatric clinics. Streptococcal pharyngitis reaches a nadir in the early school years, and it is vital to diagnose it early to avoid the serious complications that can arise from improper treatment, such as acute rheumatic fever and rheumatic heart disease.
Materials And Methods:
This is a cross-sectional multicenter study of medical house officers conducted from January to February 2018.
Results:
This study surveyed 135 house officers at Khartoum's primary health centers and hospitals. Most of the respondents were males (76/135; 56%). Most of the house officers reported seeing patients with throat complaints 1-2 times per week (58/135; 43%). The most common complication was acute rheumatic fever (65/135; 48%). Out of all the criteria of a Group A beta-hemolytic streptococcus (GAS) pharyngitis diagnosis, absence of cough and tender lymph nodes were the least recognized by house officers, i.e. 11.9% (16/135) and 45.2% (61/135), respectively. Only (4/135) 3% knew the full criteria for diagnosing bacterial pharyngitis. Throat culture was the most commonly used lab test to diagnose bacterial pharyngitis (115/135; 85.2%). The majority of participants did not recognize an IM injection of benzathine penicillin G as the first-line management of bacterial pharyngitis (101/135; 74.8%). The participants had moderate knowledge (93/135; 68.9%). Those with poor knowledge also happened to have poor practice (p = 0.009). Those who see more cases per week were also more likely to have good knowledge (p = 0.000). House officers with a moderate attitude constituted about 48.9% (66/135) of the whole sample. The most often prescribed medication was amoxicillin-clavulanic acid for one week (53/135; 39.3%). The practice score was associated with a lower knowledge (p = 0.009). Only 20.7% (28/135) of the participants in our study were adherent to the use of benzathine penicillin G as the first-line management of bacterial pharyngitis.
Conclusion:
House officers had poor-to-moderate knowledge regarding the diagnosis and management of bacterial pharyngitis, especially in regard to what antibiotic to use. However, their fear of antibiotic resistance was a good behavior.
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