Variability in the Diagnosis and Treatment of Group A Streptococcal Pharyngitis by Primary Care Pediatricians

2014 ◽  
Vol 35 (S3) ◽  
pp. S79-S85 ◽  
Author(s):  
Julie L. Fierro ◽  
Priya A. Prasad ◽  
A. Russell Localio ◽  
Robert W. Grundmeier ◽  
Richard C. Wasserman ◽  
...  
Keyword(s):  
Primary Care ◽  
Streptococcal Pharyngitis ◽  
Diagnosis And Treatment ◽  
Group A ◽  
Primary Care Pediatricians

scholarly journals Group A streptococcal pharyngitis: A practical guide to diagnosis and treatment

2021 ◽  
Vol 26 (5) ◽  
pp. 319-319
Author(s):  
Laura Sauve ◽  
A Michael Forrester ◽  
Karina A Top
Keyword(s):  
Primary Care ◽  
Acute Rheumatic Fever ◽  
Throat Swab ◽  
Group A Streptococcus ◽  
Streptococcal Pharyngitis ◽  
Clinical Syndrome ◽  
Indigenous Populations ◽  
Diagnosis And Treatment ◽  
Group A ◽  
Disproportionate Burden

Abstract Group A Streptococcus (GAS) pharyngitis is a common clinical syndrome in primary care, yet controversy remains regarding the best approach to diagnosis and treatment, including the benefits of antibiotics. Children who are likely to have GAS pharyngitis based on history or physical examination should have a throat swab and, when positive, be treated with amoxicillin or penicillin. The disproportionate burden of acute rheumatic fever in Indigenous populations in Canada and special considerations for testing and treatment are discussed.

scholarly journals Analysis of awareness of practical medicinal doctors on diagnosis and treatment of pharyngitis in children

2021 ◽  
pp. 20-35
Author(s):  
O.R. Boyarchuk ◽  
◽  
O.M. Mochulska ◽  
Keyword(s):  
Primary Care ◽  
Antibiotic Therapy ◽  
Sore Throat ◽  
Throat Swab ◽  
Tertiary Care ◽  
Streptococcal Pharyngitis ◽  
Hemolytic Streptococcus ◽  
Diagnosis And Management ◽  
Group A ◽  
Primary Care Pediatricians

Painful throat is the main symptom of pharyngitis and one of the most common reasons to refer to a primary care physician. In 60.0–70.0% of cases acute pharyngitis is caused by viruses, including rhinoviruses, adenoviruses, enteroviruses, coronaviruses and others. More then about 5.0–15.0% of pharyngitis cases in adults and around 20.0–30.0% of cases in children are caused by bacterial infections, among which group A β hemolytic Streptococcus. Among other causative agents of bacterial pharyngitis, group C and group G Streptococcus, Mycoplasma pneumoniae, Chlamydia pneumoniae and Arcanobacterium haemolyticus are also reported, although much less frequently. Severe group A β-hemolytic Streptococcus-related diseases, such as acute rheumatic fever, rheumatic heart disease, post-streptococcal glomerulonephritis, and invasive infections are accountable for more than 517 000 deaths each year. Therefore, the issue of timely diagnosis and proper management of streptococcal pharyngitis is very important. Purpose — to study, evaluate and analyze the knowledge of pediatricians in diagnosis and management of sore throat in children and to identify further ways to raise their awareness. Matherials and methods. The poll among pediatricians on evaluation of diagnosis and management of pharyngitis in children were conducted. The study involved pediatricians of Ternopil region, Ukraine. In general 112 pediatricians were questioned. Among the participants 79 (70.5%) were the primary care pediatricians and 33 (29.5%) worked as the secondary and tertiary care pediatricians. Questionnaire and statistical research methods were used. Results. Overall, 70.5% of pediatricians prescribed a throat swab for patients with pharyngitis in selected cases. However, they rarely (20.0%) used Centor or McIsaak criteria to choose management strategy of sore throat. Amoxicillin as a first-line antibiotic for streptococcal pharyngitis was chosen by 66.1% of respondents and primary care pediatricians prescribed it more often than the secondary and tertiary care pediatricians (p=0.0006), but antibiotic therapy was prescribed for 10 days only by 52.7% of respondents. Less than half of the correct answers were to questions related to the prescribing of antibacterial therapy in healthy children, in which group A β-hemolytic Streptococcus is detected in throat swab (39.3%) and in cases of positive antistreptolysin-O (25.9%). Conclusions. The research showed a wide range of knowledge of pediatricians about the diagnosis and management of group A β-hemolytic Streptococcus pharyngitis — from satisfactory responses to the prescription of antibiotic therapy to low knowledge about the diagnosis and determination of strategies in healthy carriers. These data emphasize the need to improve knowledge about the strategies of group group A β-hemolytic Streptococcus pharingytis control. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: group A β-hemolytic Streptococcus, pharyngitis, diagnosis, treatment.

scholarly journals Variability in the Diagnosis and Treatment of Group A Streptococcal Pharyngitis by Primary Care Pediatricians

2014 ◽  
Vol 35 (S3) ◽  
pp. S79-S85 ◽  
Author(s):  
Julie L. Fierro ◽  
Priya A. Prasad ◽  
A. Russell Localio ◽  
Robert W. Grundmeier ◽  
Richard C. Wasserman ◽  
...  
Keyword(s):  
Primary Care ◽  
Streptococcal Pharyngitis ◽  
Diagnosis And Treatment ◽  
Pediatric Primary Care ◽  
Antibiotic Prescribing ◽  
Acute Pharyngitis ◽  
Significant Variability ◽  
Group A ◽  
Care Practices ◽  
Primary Care Practices

Objective.To compare practice patterns regarding the diagnosis and management of streptococcal pharyngitis across pediatric primary care practices.Design.Retrospective cohort study.Setting.All encounters to 25 pediatric primary care practices sharing an electronic health record.Methods.Streptococcal pharyngitis was defined by an International Classification of Diseases, Ninth Revision code for acute pharyngitis, positive laboratory test, antibiotic prescription, and absence of an alternative bacterial infection. Logistic regression models standardizing for patient-level characteristics were used to compare diagnosis, testing, and broad-spectrum antibiotic treatment for children with pharyngitis across practices. Fixed-effects models and likelihood ratio tests were conducted to analyze within-practice variation.Results.Of 399,793 acute encounters in 1 calendar year, there were 52,658 diagnoses of acute pharyngitis, including 12,445 diagnoses of streptococcal pharyngitis. After excluding encounters by patients with chronic conditions and standardizing for age, sex, insurance type, and race, there was significant variability across and within practices in the diagnosis and testing for streptococcal pharyngitis. Excluding patients with antibiotic allergies or prior antibiotic use, off-guideline antibiotic prescribing for confirmed group A streptococcal pharyngitis ranged from 1% to 33% across practices (P < .001). At the clinician level, 13 of 25 sites demonstrated significant within-practice variability in off-guideline antibiotic prescribing (P ≤ .05). Only 18 of the 222 clinicians in the network accounted for half of all off-guideline antibiotic prescribing.Conclusions.Significant variability in the diagnosis and treatment of pharyngitis exists across and within pediatric practices, which cannot be explained by relevant clinical or demographic factors. Our data support clinician-targeted interventions to improve adherence to prescribing guidelines for this common condition.

Proposal for juvenile idiopathic arthritis guidance on diagnosis and treatment for primary care pediatricians and nonpediatric rheumatologists (2007)

2007 ◽  
Vol 17 (5) ◽  
pp. 353-363 ◽  
Author(s):  
Shumpei Yokota ◽  
Masaaki Mori ◽  
Tomoyuki Imagawa ◽  
Syuji Takei ◽  
Takuji Murata ◽  
...  
Keyword(s):  
Primary Care ◽  
Juvenile Idiopathic Arthritis ◽  
Diagnosis And Treatment ◽  
Primary Care Pediatricians
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