References

Bennett J, Moreland NJ, Zhang J, Crane J, Sika-Paotonu D, Carapetis J, Williamson DA, Baker MG Risk factors for group A streptococcal pharyngitis and skin infections: A case control study. The Lancet Regional Health – Western Pacific. 2022; 26:(1) https://doi.org/10.1016/j.lanwpc.2022.100507

Berkley J Management of Pharyngitis. Circulation. 2018; 138:(18)1920-1922 https://doi.org/10.1161/CIRCULATIONAHA.118.035900

Acute rheumatic fever--Utah. MMWR Morb Mortal Wkly Rep. 1987; 36:(8)108-110

Centers for Disease Control and Prevention. Group A Streptococcal (GAS) Disease. 2018. https//www.cdc.gov/groupastrep/diseases-public/rheumatic-fever.html (accessed 22 May 2024)

Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K The diagnosis of strep throat in adults in the emergency room. Med Decis Making. 1981; 1:(3)239-246 https://doi.org/10.1177/0272989X8100100304

Chiappini E, Regoli M, Bonsignori F, Sollai S, Parretti A, Galli L, de Martino M Analysis of different recommendations from international guidelines for the management of acute pharyngitis in adults and children. Clin Ther. 2011; 33:(1)48-58 https://doi.org/10.1016/j.clinthera.2011.02.001

Cižman M, Plankar Srovin T Antibiotic consumption and resistance of gram-negative pathogens (collateral damage). GMS Infect Dis. 2018; 6

Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH Red Book: 2021–2024 Report of the Committee on Infectious Diseases, 32nd edn. Itasca: American Academy of Pediatrics; 2021 https://doi.org/10.1542/9781610025782

Cooper RJ, Hoffman JR, Bartlett JG, Besser RE, Gonzales R, Hickner JM, Sande MA Principles of appropriate antibiotic use for acute pharyngitis in adults: background. Ann Intern Med. 2001; 134:(6)509-517 https://doi.org/10.7326/0003-4819-134-6-200103200-00019

Courtenay M, Gillespie D, Lim R Patterns of dispensed non-medical prescriber prescriptions for antibiotics in primary care across England: a retrospective analysis. J Antimicrob Chemother. 2017; 72:(10)2915-2920 https://doi.org/10.1093/jac/dkx230

Coutinho G, Duerden M, Sessa A, Caretta-Barradas S, Altiner A Worldwide comparison of treatment guidelines for sore throat. Int J Clin Pract. 2021; 75:(5) https://doi.org/10.1111/ijcp.13879

Craig R, Nickonchuk T, Korownyk C Point-of-care testing for group A streptococcal pharyngitis. Can Fam Physician. 2020; 66:(1)

Denny FW, Wannamaker LW, Brink WR, Rammelkamp CH, Custer EA Prevention of rheumatic fever; treatment of the preceding streptococcic infection. J Am Med Assoc. 1950; 143:(2)151-153 https://doi.org/10.1001/jama.1950.02910370001001

Dodd HK, Atkinson A The use of centor and/or FeverPain scoring criteria to determine antibiotic prescribing in acute sore throat according to NICE NG84 guideline. Arch Dis Child. 2021; 106:A417-A417

Acute Pharyngitis. 2021. https//bestpractice.bmj.com/topics/en-gb/5 (accessed 22 May 2024)

Duthie L, Doan L, Griffiths S, Munthali P A change in the approach to the management of sore throat in children. Arch Dis Child. 2020; 105:A80-A80

Finnish Medical Society Duodecim, Finnish Otolaryngology Association, Finnish Infectious Diseases Association, Clinical Microbiologists Association. Pharyngitis: Current care recommendation. 2020. https//www.kaypahoito.fi/hoi38020#K1 (accessed 14 May 2024)

Freer J, Ally T, Brugha R Impact of Centor scores on determining antibiotic prescribing in children. Int J Health Care Qual Assur. 2017; 30:(4)319-326 https://doi.org/10.1108/IJHCQA-08-2016-0114

General Medical Council. Good practice in prescribing and managing medicines and devices. 2021. https//www.gmc-uk.org/-/media/documents/prescribing-guidance-before-cie_pdf-85470847.pdf (accessed 22 May 2024)

Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST, Taubert KA Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis. Circulation. 2009; 119:(11)1541-1551 https://doi.org/10.1161/CIRCULATIONAHA.109.191959

Giraldez-Garcia C, Rubio B, Gallegos-Braun JF, Imaz I, Gonzalez-Enriquez J, Sarria-Santamera A Diagnosis and management of acute pharyngitis in a paediatric population: a cost–effectiveness analysis. Eur J Pediatr. 2011; 170:(8)1059-1067 https://doi.org/10.1007/s00431-011-1410-0

Greer R, Althaus T, Ling C, Intralawan D, Nedsuwan S, Thaipadungpanit J, Wangrangsimakul T, Butler C, Day N, Lubell Y Prevalence of Group A Streptococcus in Primary Care Patients and the Utility of C-Reactive Protein and Clinical Scores for Its Identification in Thailand. Am J Trop Med Hyg. 2020; 102:(2)377-383 https://doi.org/10.4269/ajtmh.19-0502

Gulliford MC, Dregan A, Moore MV, Ashworth M, Staa T, McCann G, Charlton J, Yardley L, Little P, McDermott L Continued high rates of antibiotic prescribing to adults with respiratory tract infection: survey of 568 UK general practices. BMJ Open. 2014; 4:(10) https://doi.org/10.1136/bmjopen-2014-006245

Health and Care Professions Council. Standards for prescribing. 2019. https//www.hcpc-uk.org/standards/standards-relevant-to-education-and-training/standards-for-prescribing (accessed 22 May 2024)

Hsieh TH, Chen PY, Huang FL, Wang JD, Wang LC, Lin HK, Lin HC, Hsieh HY, Yu MK, Chang CF Are empiric antibiotics for acute exudative tonsillitis needed in children?. J Microbiol Immunol Infect. 2011; 44:(5)328-332 https://doi.org/10.1016/j.jmii.2010.08.009

Kalra MG, Higgins KE, Perez ED Common Questions About Streptococcal Pharyngitis. Am Fam Physician. 2016; 94:(1)24-31

Kanji K, Saatci D, Rao GG, Khanna P, Bassett P, Williams B, Khan M Antibiotics for tonsillitis: should the emergency department emulate general practice?. J Clin Pathol. 2016; 69:(9)834-836 https://doi.org/10.1136/jclinpath-2016-203808

Kenealy T Sore throat. BMJ Clin Evid. 2014; 2014

Group A Streptococcal (GAS) Infections. 2021. https//emedicine.medscape.com/article/228936-overview (accessed 22 May 2024)

Klepser DG, Klepser ME, Dering-Anderson AM, Morse JA, Smith JK, Klepser SA Community pharmacist–physician collaborative streptococcal pharyngitis management program. J Am Pharm Assoc (Wash DC). 2016; 56:(3)323-329.e1 https://doi.org/10.1016/j.japh.2015.11.013

Koloskova OK, Bezrukov LO, Ivanova LA, Horbatiuk IB, Horbatiuk IB Optimization of clinical diagnosis and treatment of acute tonsillopharyngitis in children. Archives of the Balkan Medical Union. 2019; 54:(1)51-56 https://doi.org/10.31688/ABMU.2019.54.1.07

Koslover N, Levene T Evaluating and Improving the Management of Tonsilitis in an A&E Department: An Educational Intervention. Br J Surg. 2021; 108:vii-100

Leach O, Van Boxel G Crash Course General Medicine.London: Elsevier Mosby; 2015

Little P, Gould C, Williamson I, Warner G, Gantley M, Kinmonth AL Reattendance and complications in a randomised trial of prescribing strategies for sore throat: the medicalising effect of prescribing antibiotics. BMJ. 1997; 315:(7104)350-352 https://doi.org/10.1136/bmj.315.7104.350

Little P, Hobbs FDR, Moore M, Mant D, Williamson I, McNulty C, Cheng YE, Leydon G, McManus R, Kelly J Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management). BMJ. 2013; 347 https://doi.org/10.1136/bmj.f5806

Llor C, Hernández S, Sierra N, Moragas A, Hernández M, Bayona C Association between use of rapid antigen detection tests and adherence to antibiotics in suspected streptococcal pharyngitis. Scand J Prim Health Care. 2010; 28:(1)12-17 https://doi.org/10.3109/02813431003669301

Malley M, Driver K, Costelloe M, Monaghan I, Jefferson L, Poole L, Lewis C, Salt R, Marlow R To prescribe or not to prescribe for paediatric sore throat: a retrospective cohort study comparing clinician-led antibiotic prescriptions to FeverPAIN and Centor scoring in a tertiary paediatric emergency department and a national review of practice. Emerg Med J. 2021; 38:(8)613-616 https://doi.org/10.1136/emermed-2020-210786

Mann D, Hess R, McGinn T, Jones S, Palmisano J, Richardson S, Chokshi S, Dinh-Le C, Park L, Mishuris R Impact of an integrated clinical prediction rule on antibiotic prescription rates for acute respiratory infections in diverse primary care settings. J Gen Intern Med. 2019; 34:(2)

Marais A, Leuschner M The sore throat: a clinical approach to tonsillopharyngitis. S Afr Fam Pract. 2019; 61:(4)19-21 https://doi.org/10.4102/safp.v61i4.4957

Mathioudakis A, Rousalova I, Gagnat AA, Saad N, Hardavella G How to keep good clinical records. Breathe (Sheff). 2016; 12:(4)369-373 https://doi.org/10.1183/20734735.018016

McIsaac WJ, Kellner JD, Aufricht P, Vanjaka A, Low DE Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA. 2004; 291:(13)1587-1595 https://doi.org/10.1001/jama.291.13.1587

Moher D, Liberati A, Tetzlaff J, Altman DG Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6:(7) https://doi.org/10.1371/journal.pmed.1000097

Muthanna A, Salim HS, Hamat RA, Shamsuddin NH, Zakariah SZ Clinical Screening Tools to Diagnose Group A Streptococcal Pharyngotonsillitis in Primary Care Clinics to Improve Prescribing Habits. Malays J Med Sci. 2018; 25:(6)6-21 https://doi.org/10.21315/mjms2018.25.6.2

Muthanna A, Siti Zulaikha SZ, Abdul Rashid A, Shariff Ghazali S, Hamat RA, Mawardi M, Salim HS, Shamsuddin NH Antibiotic Prescribing Patterns for Patients with Pharyngitis in Malaysian Public Primary Care Clinics. Malays J Med Sci. 2022; 29:(1)91-100 https://doi.org/10.21315/mjms2022.29.1.9

National Institute for Health and Care Excellence. Sore throat (acute): antimicrobial prescribing NICE guideline [NG84]. 2018. https//www.nice.org.uk/guidance/ng84 (accessed 22 May 2024)

National Institute for Health Research. Point-of-care tests for group A streptococcus. 2015. https//www.community.healthcare.mic.nihr.ac.uk/reports-and-resources/horizon-scanning-reports/point-of-care-tests-for-group-a-streptococcus (accessed 22 May 2024)

Nejashmikj VR, Stojkovska S, Topuzovska IK, Stavrikj K Evidence Based Practice in Using Antibiotics for Acute Tonsillitis in Primary Care Practice. Prilozi (Makedon Akad Nauk Umet Odd Med Nauki). 2017; 38:(2)63-68 https://doi.org/10.1515/prilozi-2017-0023

NHS Confederation. Advanced and Enhanced Clinical Practice. 2022. https//www.nhsemployers.org/articles/advanced-and-enhanced-clinical-practice (accessed 22 May 2024)

Nursing and Midwifery Council. Standards for prescribers. 2019. https//www.nmc.org.uk/standards/standards-for-post-registration/standards-for-prescribers (accessed 22 May 2024)

Ong S, Nakase J, Moran GJ, Karras DJ, Kuehnert MJ, Talan DA Antibiotic use for emergency department patients with upper respiratory infections: prescribing practices, patient expectations, and patient satisfaction. Ann Emerg Med. 2007; 50:(3)213-220 https://doi.org/10.1016/j.annemergmed.2007.03.026

Palla AH, Khan RA, Gilani AH, Marra F Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study. BMC Pulm Med. 2012; 12:(1) https://doi.org/10.1186/1471-2466-12-70

Patel C, Green BD, Batt JM, Kholmurodova F, Barnes M, Geyer WJ, Benson J Antibiotic prescribing for tonsillopharyngitis in a general practice setting: can the use of Modified Centor Criteria reduce antibiotic prescribing?. Aust J Gen Pract. 2019; 48:(6)395-401 https://doi.org/10.31128/AJGP-08-18-4685

Petersen I, Hayward AC Antibacterial prescribing in primary care.: Medline; 2007 https://doi.org/10.1093/jac/dkm156

Ralph AP, Noonan S, Wade V, Currie BJ The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease. Med J Aust. 2021; 214:(5)220-227 https://doi.org/10.5694/mja2.50851

Reinholdt KB, Rusan M, Hansen PR, Klug TE Management of sore throat in Danish general practices. BMC Fam Pract. 2019; 20:(1) https://doi.org/10.1186/s12875-019-0970-3

Roggen I, van Berlaer G, Gordts F, Pierard D, Hubloue I Centor criteria in children in a paediatric emergency department: for what it is worth. BMJ Open. 2013; 3:(4) https://doi.org/10.1136/bmjopen-2013-002712

Royal Pharmaceutical Society. A Competency Framework for all Prescribers. 2021. https//www.rpharms.com/resources/frameworks/prescribing-competency-framework/competency-framework (accessed 22 May 2024)

Saengcharoen W, Jaisawang P, Udomcharoensab P, Buathong K, Lerkiatbundit S Appropriateness of diagnosis of streptococcal pharyngitis among Thai community pharmacists according to the Centor criteria. Int J Clin Pharm. 2016; 38:(5)1318-1325 https://doi.org/10.1007/s11096-016-0373-7

Seeley A, Fanshawe T, Voysey M, Hay A, Moore M, Hayward G Diagnostic accuracy of Fever-PAIN and Centor criteria for bacterial throat infection in adults with sore throat: a secondary analysis of a randomised controlled trial. BJGP Open. 2021; 5:(6) https://doi.org/10.3399/BJGPO.2021.0122

Sheridan C, Grewal K, Thompson C, Borgundvaag B, McLeod SL Antibiotic prescribing and use of corticosteroids for the emergency department management of acute uncomplicated pharyngitis. Fam Pract. 2021; 38:(6) https://doi.org/10.1093/fampra/cmab035

Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, Martin JM, Van Beneden C Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012; 55:(10)e86-e102 https://doi.org/10.1093/cid/cis629

Spinks A, Glasziou PP, Del Mar CB Antibiotics for sore throat. Cochrane Libr. 2013; 2013:(11) https://doi.org/10.1002/14651858.CD000023.pub4

Steer AC Historical aspects of rheumatic fever. J Paediatr Child Health. 2015; 51:(1)21-27 https://doi.org/10.1111/jpc.12808

Stuart B, Brotherwood H, Van't Hoff C, Brown A, van den Bruel A, Hay AD, Moore M, Little P Exploring the appropriateness of antibiotic prescribing for common respiratory tract infections in UK primary care. J Antimicrob Chemother. 2020; 75:(1)236-242

Watkins DA, Johnson CO, Colquhoun SM, Karthikeyan G, Beaton A, Bukhman G, Forouzanfar MH, Longenecker CT, Mayosi BM, Mensah GA Global, regional, and national burden of rheumatic heart disease, 1990–2015. N Engl J Med. 2017; 377:(8)713-722 https://doi.org/10.1056/NEJMoa1603693

World Health Organization. Antibiotic Resistance. 2020. https//www.who.int/news-room/fact-sheets/detail/antibiotic-resistance (accessed 21 May 2024)

Antibiotic use in the emergency department for acute sore throat

02 June 2024
Volume 6 · Issue 6

Abstract

Acute sore throat is a frequent cause of inappropriate antibiotic prescribing in primary care, despite the majority of cases being viral in nature. Following changes in consulting behaviour, many patients are now turning to emergency departments for their primary care needs. The aim of this study was to determine whether clinical scores are used between staff groups when treating acute tonsillitis in an emergency department and whether antibiotics are prescribed appropriately. A retrospective service evaluation of patients diagnosed with ‘tonsillitis’ in the emergency department over a 12-month period was conducted. Patient records were reviewed for Centor or FeverPAIN scoring documentation, antibiotic prescriptions and the clinician group providing treatment. The review found that a clinical score was documented for only 38 patients and that 44% of antibiotics were prescribed inappropriately. It is concluded that clinical scores are not being used appropriately in the emergency department to guide antibiotic prescribing for tonsillitis, leading to a high number of inappropriate prescriptions.

Acute sore throat (AST) is a common condition, with 31% of all adults reporting it in 2014; of these, 38% visited a GP for treatment (Kenealy, 2014). The majority of ASTs have an unknown or viral aetiology, with Group A beta-haemolytic Streptococcus (GABHS) identified in only 5–15% of all cases (Cooper et al, 2001). This percentage is lower in children, in whom 1% have GABHS-positive swabs (Hsieh et al, 2011). AST with a viral or bacterial cause is predominantly a self-limiting condition that resolves with simple symptom relief alone (Donowitz, 2021); approximately 40% of cases spontaneously resolve within 3 days of onset.

Historically, untreated GABHS was linked to high rates of acute rheumatic fever (Centers for Disease Control and Prevention, 2018). Early and aggressive antibiotic treatment for AST has been found to reduce rates of the disease and has become a key reason for antibiotic prescribing; however, Petersen et al (2007) found that antibiotics were prescribed unnecessarily to 64% of primary care patients whose AST was not found to be caused by GABHS. This raises concerns around prescribing stewardship, the risks associated with inappropriate antimicrobials and the harm that can be caused by unnecessary treatments. A Cochrane review (Spinks et al, 2013) found that antibiotics provided only modest resolution of symptoms, shortening symptom duration by 16 hours compared to symptom relief alone.

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