Worldwide Comparison of Treatment Guidelines for Sore Throat

Abstract

Sore throat (acute pharyngitis) is globally one of the most frequent reasons for seeking healthcare. Its etiology is mostly viral. In 15-30% of cases, group A streptococci (GAS) are detected, which may cause acute rheumatic fever. We have done a worldwide systematic review to compare diagnostic and therapeutic guidelines across countries and regions. Previous reviews of sore throat guidelines were limited to specific regions and/or language; this is the first global review. Searches were performed in MEDLINE, EMBASE and COCHRANE (key words: sore throat, pharyngitis, tonsillitis or pharyngotonsillitis, and management, guidance, guideline or recommendation) and on the web sites of major health authorities and associated institutions from Africa, Asia, Europe, Middle East, North America, Oceania and South America. Thirty-six guidelines were identified from 26 countries. Most common are recommendations relying on the symptom-and age-based Centor or McIsaac scores. However, antibiotic treatment may be based on other symptomatic criteria; in the most extreme approach just sore throat in children. The recommendation of GAS-specific diagnostic tests is mainly limited to countries where such tests are readily available, although some countries choose not to use them. Penicillins are consistently recommended as first-line antibiotics. By contrast, guidance for symptomatic treatment is variable and mostly sparse or missing. African countries without sore throat guidelines and Asian countries bypassing them are afflicted by rising antibiotic resistance. The availability of sore throat guidelines varies considerably by region and country. Moreover, important divergence is found among the guidelines regarding diagnostic and treatment criteria. This may be explained by the historical background or adoption of external guidelines, rather than the local incidences of GAS infections or acute rheumatic fever. Absence of recommendations on symptomatic treatment in many guidelines is concerning, and raises issues about antimicrobial stewardship, as this is the mainstay of sore throat management, rather than antibiotics. REVIEW CRITERIASearches for guidelines were performed in the COCHRANE Library (Systematic Reviews), EMBASE (entire database) and PUBMED (all databases, including MEDLINE), using the search terms, criteria and cut-offs defined in the manuscript. Further guideline searches were performed on the internet, with the Google search engine using the specified English search terms, and their translations in Arabic, Chinese, French, German, Portuguese, Russian and Spanish, as well as on the websites of the major health authorities and associated institutions of all regions worldwide.Only guidelines that provided recommendations for the diagnosis and the treatment of sore throat (acute pharyngitis) in general were considered and included. For Europe and the USA, where large numbers of Posted on Authorea

The use of paracetamol for first-line treatment of acute sore throat. A descriptive generic qualitative study of GPs and patients

“…Worldwide, most guidelines focus on antibiotics as a treatment [7]. Only 11 guidelines, like the European Society for Clinical Microbiology and Infectious Diseases, Germany, Sweden and the UK, explicitly advise the combination of paracetamol and a NSAID [7][8][9][10]. In contrast, the Dutch guideline discourages the use of NSAIDs [3].…”