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Strategies for managing group A streptococcal pharyngitis. A survey of board-certified pediatricians
1Department of Pediatrics, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Ill., USA.
Insights
Most pediatricians manage group A beta-hemolytic streptococcal (GABHS) pharyngitis appropriately. However, some use non-recommended diagnostic and treatment strategies, with varied approaches for recurrent GABHS pharyngitis and chronic carriage.
Area of Science:
- Infectious Diseases
- Pediatric Medicine
- Microbiology
Background:
- Group A beta-hemolytic streptococcal (GABHS) pharyngitis is a common pediatric infection requiring appropriate management to prevent complications.
- Pediatrician knowledge and adherence to evidence-based guidelines for GABHS pharyngitis are crucial for effective patient care.
Purpose of the Study:
- To evaluate the current management strategies and assess the knowledge of board-certified pediatricians concerning GABHS pharyngitis.
- To identify variations in diagnostic and treatment approaches for acute, recurrent, and chronic GABHS pharyngitis.
Main Methods:
- A survey was conducted in 1991 among 1000 randomly selected US pediatricians from the American Academy of Pediatrics.
- The survey included clinical scenarios, demographic information, and questions assessing knowledge of streptococcal pharyngitis.
- Data from 510 responding pediatricians who treated pharyngitis were analyzed using Chi-squared and Student's t-tests.
Main Results:
- Antigen detection tests (ADTs) and throat cultures were utilized by 64% and 85% of pediatricians, respectively.
- Diagnostic strategies varied, with 42% considering positive ADTs definitive and using throat cultures for negative results.
- Thirty-one percent initiated antibiotic treatment before test results, with only 29% discontinuing antibiotics if GABHS was not confirmed.
Conclusions:
- While most pediatricians employed appropriate strategies for acute GABHS pharyngitis, 15-20% utilized non-recommended methods.
- A lack of consensus was observed regarding the management of recurrent GABHS pharyngitis and chronic GABHS carriage.
- Further standardization of GABHS pharyngitis management, particularly for complex cases, is warranted.
Objective:
To assess the management strategies and knowledge of board-certified pediatricians regarding group A beta-hemolytic streptococcal (GABHS) pharyngitis.
Design:
Survey of 1000 US pediatricians in 1991, chosen randomly from the membership of the American Academy of Pediatrics. The survey included questions related to 2 clinical scenarios, respondent demographics, and knowledge of streptococcal pharyngitis.
Subjects:
Pediatricians who treated patients with pharyngitis. Of the 690 surveys that were returned, 510 pediatricians treated patients with pharyngitis and were included in the data analysis.
Data Analysis:
Data were analyzed using Chi 2 statistics for categorical data and the Student t test for continuous variables.
Results:
Antigen detection tests (ADTs) were used by 64% of the pediatricians; 85% used throat cultures. Strategies for diagnosing streptococcal pharyngitis were throat culture alone (38%), consider positive ADTs definitive and use throat culture when ADTs are negative (42%), ADT alone (13%), ADT and throat culture for all patients with pharyngitis (5%), and no tests for GABHS performed (2%). Thirty-one percent usually or always treated with antibiotics before test results were available. Only 29% of these "early treaters" always discontinued antibiotics when tests did not confirm the presence of group A streptococci. The drug of choice for treatment was penicillin (73%); another 26% preferred a derivative of penicillin, particularly amoxicillin. Many pediatricians altered their management when a patient had recurrent streptococcal pharyngitis. Nearly half of the respondents would use a different antibiotic than they used for routine acute streptococcal pharyngitis. They most often changed to erythromycin (25%), cefadroxil (23%), or amoxicillin-clavulanate (20%). Follow-up throat culture was obtained by 51% of pediatricians after treatment of recurrent streptococcal pharyngitis. A patient with chronic carriage of GABHS and symptoms of pharyngitis would be treated with an antibiotic by 84%; most (62%) would use a penicillin. Other choices were cephalosporins (19%), erythromycin (12%), clindamycin (3%), or rifampin plus penicillin (3%). Tonsillectomy was recommended for symptomatic carriers by 31% of respondents. Carriers without symptoms were less likely to be treated with antibiotics (23%) or referred for tonsillectomy (21%).
Conclusions:
Most surveyed board-certified pediatricians managed acute GABHS pharyngitis appropriately, but 15% to 20% used diagnostic or treatment strategies that are not recommended. There was lack of a consensus about the management of recurrent GABHS pharyngitis and chronic carriage of GABHS.