Guideline for the management of acute sore throat

Abstract

Clin Microbiol Infect 2012; 18 (Suppl. 1): 1–27 Abstract The European Society for Clinical Microbiology and Infectious Diseases established the Sore Throat Guideline Group to write an updated guideline to diagnose and treat patients with acute sore throat. In diagnosis, Centor clinical scoring system or rapid antigen test can be helpful in targeting antibiotic use. The Centor scoring system can help to identify those patients who have higher likelihood of group A streptococcal infection. In patients with high likelihood of streptococcal infections (e.g. 3–4 Centor criteria) physicians can consider the use of rapid antigen test (RAT). If RAT is performed, throat culture is not necessary after a negative RAT for the diagnosis of group A streptococci. To treat sore throat, either ibuprofen or paracetamol are recommended for relief of acute sore throat symptoms. Zinc gluconate is not recommended to be used in sore throat. There is inconsistent evidence of herbal treatments and acupuncture as treatments for sore throat. Antibiotics should not be used in patients with less severe presentation of sore throat, e.g. 0–2 Centor criteria to relieve symptoms. Modest benefits of antibiotics, which have been observed in patients with 3–4 Centor criteria, have to be weighed against side effects, the effect of antibiotics on microbiota, increased antibacterial resistance, medicalisation and costs. The prevention of suppurative complications is not a specific indication for antibiotic therapy in sore throat. If antibiotics are indicated, penicillin V, twice or three times daily for 10 days is recommended. At the present, there is no evidence enough that indicates shorter treatment length.

Prevention and treatment of the common cold: making sense of the evidence

“…More details regarding primary conditions whose signs and symptoms overlap with those of the common cold are available in guidelines and review articles on allergic rhinitis, 25 sore throat, 26 sinusitis, 21 otitis media 24 and influenza. 27,28 In addition, the National Institute for Health and Care Excellence (NICE) has released a primary care guide for prescribing antibiotics for upper respiratory tract infections.…”

Rapid Diagnostic Tests for Group A Streptococcal Pharyngitis: A Meta-analysis

“…The recent European guidelines recommend using the Centor criteria to guide the use of RADTs in the diagnosis of GAS pharyngitis; physicians can consider the use of RADTs in patients with 3 to 4 Centor criteria, whereas there is no need to routinely use RADTs in patients with 0 to 2 criteria. 4 These guidelines do not recommend a backup culture for negative RADTs in either adults or children. 9 The reasons for these differences in recommendations are not immediately clear, but may relate to differing opinions between the expert groups as to the perceived necessity of treating GAS pharyngitis to prevent suppurative and nonsuppurative complications, particularly acute rheumatic fever.…”

“…However, this rule identifies only 53% of patients with GAS culturepositive sore throat even when all 4 criteria are present. 4,5 Therefore, if the clinician intends to treat GAS pharyngitis, it is generally recommended that laboratory confirmation of the presence of GAS be sought to limit unnecessary antibiotic prescription.…”

“…Previous reviews of RADT performance have identified considerable variability in the diagnostic accuracy, especially sensitivity, between different test methodologies. 4,11 The American guidelines recommend that negative RADTs in children and adolescents should be backed up by a throat culture to reduce the number of missed GAS pharyngitis cases. 9 These guidelines, along with European guidelines, 4 suggest that a backup culture in adults is not necessary because the incidence of GAS pharyngitis is generally lower than in children and because the risk of rheumatic fever is low.…”

“…4,11 The American guidelines recommend that negative RADTs in children and adolescents should be backed up by a throat culture to reduce the number of missed GAS pharyngitis cases. 9 These guidelines, along with European guidelines, 4 suggest that a backup culture in adults is not necessary because the incidence of GAS pharyngitis is generally lower than in children and because the risk of rheumatic fever is low. However, most RADTs have high specificity, meaning that a positive RADT result does not require a backup culture and that the rate of overdiagnosis is low.…”