| Background |
- Only 5-15% of adult cases of acute pharyngitis are caused by GABHS.
- It is estimated that 3,000 to 4,000 patients with GABHS must be treated for every 1 case of acute rheumatic fever prevented.
- Antibiotic therapy of GABHS hastens resolution by 1-2 days if initiated within 2-3 days of symptom onset.
|
| Diagnosis |
- Lab testing is not indicated in all patients with pharyngitis. Instead, all adults should be screened for the following:
- History of fever
- Lack of cough
- Tonsillar exudates
- Tender anterior cervical adenopathy
- Patients with none or only one of these findings should not be tested or treated for GABHS.
- Any one of the following three strategies is appropriate for patients with two or more of the above findings:
- Rapid streptococcal antigen test (RAT) for patients with 2 or more criteria, with antibiotic therapy restricted to those with positive test results.
- Rapid streptococcal antigen testing of patients with 2 or 3 criteria, with antibiotic therapy restricted to patients with all 4 findings and those with positive test results.
- Empiric antibiotic therapy for patients with 3 or 4 criteria; no diagnostic testing.
- Cultures are not recommended for routine evaluation of adult pharyngitis or for confirmation of negative results on rapid antigen tests if test sensitivity >80%.
- Throat cultures maybe useful for outbreak investigation, monitoring rates of antibiotic resistance, or when other pathogens (e.g., gonococcus) are being considered.
|
|
Comparison of
Diagnostic Strategies* |
| |
Test for 2+
criteria and
treat positives |
Empiric treatment for 3-4 criteria |
% of patients
with GABHS who are correctly
treated |
60%-70% |
70%-80% |
% of patients
receiving antibiotics |
11% |
33% |
|
*Assumptions: RAT sensitivity = 80%; RAT specificity = 90%; GABHS prevalence = 10%.
|
| Treatment |
 |
Penicillin is recommended for initial treatment of GABHS. |
 |
Erythromycin is recommended for penicillin-allergic patients. |
|
Penicillin-resistant GABHS have not been reported in the United States. |
|
Extended spectrum macrolides and fluoroquinolones are not appropriate for uncomplicated GABHS pharyngitis. |
|
TIPS TO REDUCE
ANTIBIOTIC USE |
|
Tell patients that antibiotic use increases the risk of an antibioticresistant infection. |
|
Identify and validate patient concerns. |
|
Recommend specific
symptomatic therapy. |
|
Spend time answering questions and offer a contingency plan if symptoms worsen. |
|
Provide patient education materials on antibiotic resistance. |
|
REMEMBER: Effective communication is more important than an antibiotic for patient satisfaction. |
|
See www.cdc.gov/
drugresistance/
community or contact your local health department for more information and patient education materials. |
|
Key Reference
Cooper RJ et al. Principles of appropriate antibiotic use for acute pharyngitis in adults: Background. Annals of Internal Medicine 2001;134(6):509-17. |
|
