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General Practitioner's Practice in Romanian Children with Streptococcal Pharyngitis
Reka Borka Balas1, Lorena Elena Meliț2, Ancuța Lupu3
1Department of Pediatrics I, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, Gheorghe Marinescu Street, No. 38, 540136 Targu Mures, Romania.
Insights
Romanian general practitioners often diagnose beta-hemolytic group A streptococcus (GAS) pharyngitis based on clinical signs rather than diagnostic tests. While preferring targeted antibiotic therapy, they frequently rely on symptoms for treatment decisions.
Area of Science:
- Infectious Diseases
- Pediatrics
- General Practice
Background:
- Accurate diagnosis of group A streptococcus (GAS) pharyngitis is crucial for preventing complications and avoiding unnecessary antibiotic use.
- Pediatric GAS-pharyngitis management in Romania by general practitioners (GPs) requires assessment.
Purpose of the Study:
- To evaluate the diagnostic and therapeutic approaches for pediatric GAS-pharyngitis among Romanian GPs.
- To identify discrepancies between preferred treatment strategies and actual diagnostic practices.
Main Methods:
- A cross-sectional study utilizing questionnaires distributed to Romanian GPs.
- Data collected from 56 GPs regarding their management of GAS-pharyngitis.
Main Results:
- Most GPs (92.9%) consider white tonsillar exudate the most suggestive clinical sign.
- Diagnostic tool utilization was low: Centor Criteria (25%), rapid antigen detection tests (10.7%), throat culture (42.9%).
- Antibiotic therapy was often initiated based on clinical symptoms, with amoxicillin-clavulanate being the most common choice.
Conclusions:
- Romanian GPs primarily rely on clinical symptoms for GAS-pharyngitis diagnosis, with limited use of recommended diagnostic tools.
- Despite stating a preference for targeted antibiotic therapy, diagnostic practices do not fully support this approach.
- Short-course antibiotic therapy was commonly prescribed, indicating a potential deviation from standard treatment durations.
Abstract:
Background and Objectives: A correct diagnosis of beta-hemolytic group A streptococcus (GAS)-pharyngitis allows the prevention of complications and unnecessary use of antibiotics. The aim of this study was to assess the management of pediatric GAS-pharyngitis in Romanian general practitioners (GPs)' practice. Material and Methods: a cross-sectional study was conducted using a questionnaire distributed to Romanian GPs. Results: In total, 56 GPs completed the questionnaire, mostly females (83.9%, n = 47) from an urban area (60.7%, n = 34). They treated 5-10 (35.7%) or more than 10 (32.1%) cases of GAS monthly and considered white exudate on tonsils (92.9%, n = 52) to be the most suggestive clinical sign. Of the GPs, 25% (n = 14) used the Centor Criteria, 10.7% (n = 6) performed a rapid antigen detection test, and 42.9% (n = 24) requested throat culture for diagnosis. The younger GPs used the Centor Criteria significantly more often (p = 0.027) than the older ones. Most GPs (69.6%, n = 39) preferred targeted antibiotic therapy. Amoxicillin-clavulanate was the most commonly used antibiotic (55.4%, n = 31). Most GPs preferred oral antibiotics (89%, n = 50) for 10 days (55.4%, n = 31). Conclusions: Antibiotic treatment was initiated mostly based on clinical symptoms and in a short-course therapy. GPs stated that they prefer targeted antibiotic therapy, but they did not use proper diagnostic tools.
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