Strategies for managing group A streptococcal pharyngitis. A survey of board-certified pediatricians.

Abstract

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.

• Authors: C Hofer, H J Binns, R R Tanz
• Journal: Archives of pediatrics & adolescent medicine (Arch Pediatr Adolesc Med) Vol. 151 Issue 8 Pg. 824-9 (Aug 1997) ISSN: 1072-4710 [Print] United States
• PMID: 9265886 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents

Topics

• Acute Disease
• Anti-Bacterial Agents (therapeutic use)
• Certification
• Child
• Female
• Humans
• Male
• Pediatrics (methods)
• Pharyngitis (diagnosis, drug therapy, microbiology)
• Practice Patterns, Physicians'
• Recurrence
• Streptococcal Infections (diagnosis, drug therapy, microbiology)
• Streptococcus pyogenes
• Surveys and Questionnaires
• United States