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Streptococcal diagnostic testing and antibiotics prescribed for pediatric tonsillopharyngitis
A G Mainous1, R J Zoorob, F P Kohrs
1Department of Family Practice, University of Kentucky, Lexington, USA.
Insights
Kentucky physicians rarely used recommended diagnostic tests for pediatric tonsillopharyngitis, leading to frequent antibiotic prescriptions. Current practices deviate from established pediatric guidelines for streptococcal sore throat management.
Area of Science:
- Pediatric infectious diseases
- Healthcare quality improvement
- Antibiotic stewardship
Background:
- Pediatric tonsillopharyngitis is a common condition requiring accurate diagnosis.
- Group A Streptococcus (GAS) is a primary bacterial cause requiring specific treatment.
- Adherence to clinical guidelines is crucial for effective management and antibiotic stewardship.
Purpose of the Study:
- To evaluate the utilization of streptococcal diagnostic tests for pediatric tonsillopharyngitis.
- To assess the rate of empiric antibiotic prescribing for pediatric tonsillopharyngitis in Kentucky.
- To compare current practices with American Academy of Pediatrics (AAP) guidelines.
Main Methods:
- Cross-sectional analysis of 1-year Kentucky Medicaid claims data.
- Inclusion of ambulatory encounters for individuals aged 3-17 years with tonsillopharyngitis.
- Examination of encounters coded for tonsillopharyngitis and specific streptococcal sore throat.
Main Results:
- Diagnostic tests for GAS tonsillopharyngitis were used in only 22% of all encounters and 36% of specific streptococcal sore throat encounters.
- Antibiotics were prescribed in 72% of tonsillopharyngitis encounters and 68% of streptococcal sore throat encounters, often without prior diagnostic testing.
- Urban physicians were more likely to use diagnostic tests than rural physicians (P=0.0001).
Conclusions:
- Kentucky Medicaid practices for pediatric tonsillopharyngitis do not align with AAP guidelines.
- Underutilization of diagnostic testing and high rates of empiric antibiotic use are prevalent.
- This suggests a need for improved adherence to evidence-based guidelines to optimize care and combat antibiotic resistance.
Background:
This study examined a 1-year cross-sectional sample of Kentucky Medicaid claims for the use of streptococcal diagnostic tests for pediatric tonsillopharyngitis and the empiric use of antibiotics.
Methods:
Subjects were individuals older than 3 and younger than 18 years old seen in an ambulatory setting for tonsillopharyngitis; 3478 individuals accounted for the 5067 separate outpatient and emergency room encounters for pediatric tonsillopharyngitis; 849 encounters coded as streptococcal sore throat were also examined.
Results:
Diagnostic tests for group A streptococcal tonsillopharyngitis were performed in only 22% (n = 1130) of the tonsillopharyngitis encounters and 36% (n = 306) of the streptococcal sore throat encounters. Urban physicians were more likely than rural physicians to use a diagnostic test (P = 0.0001). Emergency room encounters and outpatient encounters were not significantly different in the likelihood of having a diagnostic test (P = 0.16). In encounters for tonsillopharyngitis antibiotics were prescribed in 72% of the total encounters and in 73% of the encounters without a diagnostic streptococcal test. In encounters for streptococcal sore throat, antibiotics were prescribed for 68% of the total encounters and 69% of the encounters without a diagnostic streptococcal test.
Conclusions:
Current practices in the Kentucky Medicaid program do not follow the American Academy of Pediatrics guidelines for streptococcal tonsillopharyngitis.
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