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Reconsidering sore throats. Part I: Problems with current clinical practice

W J McIsaac1, V Goel, P M Slaughter

  • 1Institute for Clinical Evaluative Sciences, North York, Ont. w.mcisaac@utoronto.ca

Canadian Family Physician Medecin De Famille Canadien
|March 1, 1997
PubMed
Summary

Current management of Group A Streptococcus pharyngitis (strep throat) is controversial and leads to antibiotic overuse. Evidence suggests current physician practices may not prevent rheumatic fever and contribute to antibiotic resistance.

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Area of Science:

  • Family Medicine
  • Infectious Diseases
  • Clinical Practice Guidelines

Background:

  • Group A Streptococcus pharyngitis, commonly known as strep throat, presents a management dilemma for family physicians.
  • The controversy surrounding its treatment stems from balancing the need to prevent complications like rheumatic fever with concerns about antibiotic overuse and resistance.

Purpose of the Study:

  • To provide evidence-based answers to clinical questions regarding Group A Streptococcus pharyngitis.
  • To elucidate the reasons behind the controversial management strategies for this common infection.

Main Methods:

  • Literature review focusing on randomized trials, community prevalence studies, and criterion standard studies of physician clinical judgment.
  • Analysis of the effectiveness of current diagnostic and management practices.

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Main Results:

  • Limited evidence from randomized trials was available for most clinical questions.
  • High-quality prevalence and clinical judgment studies indicate that current physician management is unlikely to prevent rheumatic fever due to low healthcare-seeking behavior for sore throats.
  • Existing clinical practices contribute to the overuse of antibiotics, driven by limitations in diagnostic accuracy.

Conclusions:

  • The current approach to managing upper respiratory infections, including strep throat, incurs significant healthcare costs.
  • Increasing rates of antibiotic resistance necessitate a critical re-evaluation of conventional management strategies.
  • An alternative, evidence-based management strategy is proposed for future consideration.