Best management of patients with an acute sore throat – a critical analysis of current evidence and a consensus of experts from different countries and traditions

References

• André M, Vernby Å, Odenholt I, et al. Diagnosis-prescribing surveys in 2000, 2002 and 2005 in Swedish general practice: consultations, diagnosis, diagnostics and treatment choices. Scand J Infect Dis. 2008;40(8):648–654.
   PubMed Web of Science ®Google Scholar
• Tyrstrup M, Beckman A, Molstad S, et al. Reduction in antibiotic prescribing for respiratory tract infections in Swedish primary care – a retrospective study of electronic patient records. BMC Infect Dis. 2016;16:709.
   PubMed Web of Science ®Google Scholar
• Armstrong GL, Pinner RW. Outpatient visits for infectious diseases in the United States, 1980 through 1996. Arch Intern Med. 1999;159(21):2531–2536.
   PubMedGoogle Scholar
• Gunnarsson R, Orda U, Elliott B, et al. What is the optimal strategy for managing primary care patients with an uncomplicated acute sore throat? Comparing the consequences of nine different strategies using a compilation of previous studies. BMJ Open. 2022;12(4):e059069.
   PubMed Web of Science ®Google Scholar
• National Institute for Health and Care Excellence (NICE). NICE Guideline [NG84] – sore throat (acute): antimicrobial prescribing. 2018. Available from: https://www.nice.org.uk/guidance/ng84
   Google Scholar
• Scottish Intercollegiate Guidelines Network (SIGN). SIGN Guideline [117] – management of sore throat and indications for tonsillectomy. A national clinical guideline. 2010. Available from: https://www.nice.org.uk/guidance/ng84
   Google Scholar
• Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):1279–1282.
   PubMed Web of Science ®Google Scholar
• Pelucchi C, Grigoryan L, Galeone C, ESCMID Sore Throat Guideline Group, et al. Guideline for the management of acute sore throat. Clin Microbiol Infect. 2012;18(Suppl 1):1–28.
   PubMed Web of Science ®Google Scholar
• Hoare KJ, Ward E, Arroll B. International sore throat guidelines and international medical graduates: a mixed methods systematic review. J Prim Health Care. 2016;(1):20–29.
   PubMedGoogle Scholar
• Mustafa Z, Ghaffari M. Diagnostic methods, clinical guidelines, and antibiotic treatment for group A streptococcal pharyngitis: a narrative review. Front Cell Infect Microbiol. 2020;10:563627.
   PubMed Web of Science ®Google Scholar
• Gunnarsson RK, Ebell M, Wächtler H, et al. The association between guidelines and medical practitioners’ perception of best management for patients attending with an apparently uncomplicated acute sore throat – a cross-sectional survey in five countries. BMJ Open. 2020;10(9):e037884.
   PubMed Web of Science ®Google Scholar
• Gunnarsson RK, Holm SE, Söderström M. The prevalence of beta-haemolytic streptococci in throat specimens from healthy children and adults. Implications for the clinical value of throat cultures. Scand J Prim Health Care. 1997;15(3):149–155.
   PubMed Web of Science ®Google Scholar
• Hedin K, Bieber L, Lindh M, et al. The aetiology of pharyngotonsillitis in adolescents and adults – Fusobacterium necrophorum is commonly found. Clin Microbiol Infect. 2015;21(3):263.e1–263.e7.
   Google Scholar
• Gunnarsson RK, Manchal N. Group C beta haemolytic Streptococci as a potential pathogen in patients presenting with an uncomplicated acute sore throat – a systematic literature review and meta-analysis. Scand J Prim Health Care. 2020;38(2):226–237.
   PubMed Web of Science ®Google Scholar
• Lindbaek M, Hoiby EA, Lermark G, et al. Clinical symptoms and signs in sore throat patients with large colony variant β-haemolytic streptococci groups C or G versus group A. Br J Gen Pract. 2005;55(517):615–619.
   PubMed Web of Science ®Google Scholar
• Tiemstra J, Miranda RL. Role of non-group A streptococci in acute pharyngitis. J Am Board Fam Med. 2009;22(6):663–669.
   PubMed Web of Science ®Google Scholar
• Little P, Moore M, Hobbs FDR, PRISM investigators, et al. PRImary care Streptococcal Management (PRISM) study: identifying clinical variables associated with Lancefield group A β-haemolytic streptococci and Lancefield non-Group A streptococcal throat infections from two cohorts of patients presenting with an acute sore throat. BMJ Open. 2013;3(10):e003943.
   PubMed Web of Science ®Google Scholar
• Centor RM, Atkinson TP, Ratliff AE, et al. The clinical presentation of Fusobacterium-positive and streptococcal-positive pharyngitis in a university health clinic: a cross-sectional study. Ann Intern Med. 2015;162(4):241–247.
   Google Scholar
• Woldan-Gradalska P, Gradalski W, Gunnarsson R, et al. Group A beta haemolytic streptococci as a pathogen in patients presenting with an uncomplicated acute sore throat – a systematic literature review and meta-analysis considering climate zone and patient’s age. (Submitted manuscript). 2022.
   Google Scholar
• Klug TE, Rusan M, Fuursted K, et al. A systematic review of Fusobacterium necrophorum-positive acute tonsillitis: prevalence, methods of detection, patient characteristics, and the usefulness of the Centor score. Eur J Clin Microbiol Infect Dis. 2016;35(12):1903–1912.
   PubMed Web of Science ®Google Scholar
• Malmberg S, Petrén S, Gunnarsson R, et al. Acute sore throat and Fusobacterium necrophorum in primary health care – a systematic review and meta-analysis. BMJ Open. 2021;11(6):e042816.
   PubMed Web of Science ®Google Scholar
• Gunnarsson RK, Lanke J. The predictive value of microbiologic diagnostic tests if asymptomatic carriers are present. Stat Med. 2002;21:1773–1785.
   PubMed Web of Science ®Google Scholar
• Orda U, Gunnarsson RK, Orda S, et al. Etiologic predictive value of a rapid immunoassay for detection of group A streptococci antigen from throat swabs in patients presenting with a sore throat. North American Primary Care Research Group (NAPCRG) Annual Meeting; 2016 Nov 12–16; Colorado Springs, CO, USA. 2016. Available from: https://www.youtube.com/watch?v=YHMeQuKOYpw
   Google Scholar
• Spinks A, Glasziou PP, Del Mar CB. Antibiotics for treatment of sore throat in children and adults. Cochrane Database Syst Rev. 2021;12(12):CD000023.
   PubMedGoogle Scholar
• Nygren D, Wasserstrom L, Holm K, et al. Associations between findings of Fusobacterium necrophorum or β-hemolytic streptococci and complications in pharyngotonsillitis – a registry-based study in Southern Sweden. Clin Infect Dis. 2023;76(3):e1428–e1435.
   PubMedGoogle Scholar
• Lemierre A. On certain septicaemias due to anaerobic organisms. Lancet. 1936;227(5874):701–703.
   Google Scholar
• Fine AM, Nizet V, Mandl KD. Large-scale validation of the Centor and McIsaac scores to predict group A streptococcal pharyngitis. Arch Intern Med. 2012;172(11):847–852.
   PubMedGoogle Scholar
• Centor RM, Witherspoon JM, Dalton HP, et al. The diagnosis of strep throat in adults in the emergency room. Med Decis Making. 1981;1(3):239–246.
   PubMedGoogle Scholar
• McIsaac WJ, White D, Tannenbaum D, et al. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ. 1998;158(1):75–83.
   Google Scholar
• McIsaac WJ, Goel V, To T, et al. The validity of a sore throat score in family practice. CMAJ. 2000;163(7):811–815.
   PubMed Web of Science ®Google Scholar
• Little P, Hobbs FD, Moore M, PRISM investigators, et al. Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management). BMJ. 2013;347:f5806.
   PubMed Web of Science ®Google Scholar
• Little P, Stuart B, Hobbs FD, DESCARTE investigators, et al. Predictors of suppurative complications for acute sore throat in primary care: prospective clinical cohort study. BMJ. 2013;347:f6867.
   PubMedGoogle Scholar
• Watkins DA, Johnson CO, Colquhoun SM, et al. Global, regional, and national burden of rheumatic heart disease, 1990-2015. N Engl J Med. 2017;377(8):713–722.
   PubMed Web of Science ®Google Scholar
• Catanzaro FJ, Stetson CA, Morris AJ, et al. The role of the streptococcus in the pathogenesis of rheumatic fever. Am J med. 1954;17(6):749–756.
   Google Scholar
• Lennon D, Anderson P, Kerdemilidis M, et al. First presentation acute rheumatic fever is preventable in a community setting: a school-based intervention. Pediatr Infect Dis J. 2017;36(12):1113–1118.
   PubMed Web of Science ®Google Scholar
• Robertson KA, Volmink JA, Mayosi BM. Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis. BMC Cardiovasc Disord. 2005;5(1):11.
   PubMedGoogle Scholar
• Beaton A, Okello E, Rwebembera J, et al. Secondary antibiotic prophylaxis for latent rheumatic heart disease. N Engl J Med. 2022;386(3):230–240.
   PubMed Web of Science ®Google Scholar
• Kevat PM, Reeves BM, Ruben AR, et al. Adherence to secondary prophylaxis for acute rheumatic fever and rheumatic heart disease: a systematic review. Curr Cardiol Rev. 2017;13(2):155–166.
   PubMedGoogle Scholar
• Kevat PM, Gunnarsson R, Reeves BM, et al. Adherence rates and risk factors for suboptimal adherence to secondary prophylaxis for rheumatic fever. J Paediatr Child Health. 2020;57(3):419–424.
   PubMed Web of Science ®Google Scholar
• Pichichero ME, Disney FA, Talpey WB, et al. Adverse and beneficial effects of immediate treatment of Group A beta-hemolytic streptococcal pharyngitis with penicillin. Pediatr Infect Dis J. 1987;6(7):635–643.
   Google Scholar
• Nelson JD. The effect of penicillin therapy on the symptoms and signs of streptococcal pharyngitis. Pediatr Infect Dis. 1984;3(1):10–13.
   Google Scholar
• Krober MS, Bass JW, Michels GN. Streptococcal pharyngitis. Placebo-controlled double-blind evaluation of clinical response to penicillin therapy. JAMA. 1985;253(9):1271–1274.
   Google Scholar
• Zwart S, Rovers MM, de Melker RA, et al. Penicillin for acute sore throat in children: randomised, double blind trial. BMJ. 2003;327(7427):1324.
   PubMedGoogle Scholar
• De Meyere M, Mervielde Y, Verschraegen G, et al. Effect of penicillin on the clinical course of streptococcal pharyngitis in general practice. Eur J Clin Pharmacol. 1992;43(6):581–585.
   Google Scholar
• Middleton DB, D'Amico F, Merenstein JH. Standardized symptomatic treatment versus penicillin as initial therapy for streptococcal pharyngitis. J Pediatr. 1988;113(6):1089–1094.
   Google Scholar
• Dagnelie CF, van der Graaf Y, De Melker RD. Do patients with sore throat benefit from penicillin? A randomized double-blind placebo-controlled clinical trial with penicillin V in general practice. Br J Gen Pract. 1996;46(411):589–593.
   Google Scholar
• Petersen K, Phillips RS, Soukup J, et al. The effect of erythromycin on resolution of symptoms among adults with pharyngitis not caused by group A streptococcus. J Gen Intern Med. 1997;12(2):95–101.
   PubMed Web of Science ®Google Scholar
• Zwart S, Sachs AP, Ruijs GJ, et al. Penicillin for acute sore throat: randomised double blind trial of seven days versus three days treatment or placebo in adults. BMJ. 2000;320(7228):150–154.
   PubMedGoogle Scholar
• Bank S, Christensen K, Kristensen LH, et al. A cost-effectiveness analysis of identifying Fusobacterium necrophorum in throat swabs followed by antibiotic treatment to reduce the incidence of Lemierre’s syndrome and peritonsillar abscesses. Eur J Clin Microbiol Infect Dis. 2013;32(1):71–78.
   PubMed Web of Science ®Google Scholar
• Seeley A, Fanshawe T, Voysey M, et al. Diagnostic accuracy of Fever-PAIN and Centor criteria for bacterial throat infection in adults with sore throat: a secondary analysis of a randomised controlled trial. BJGP Open. 2021;5(6):20211214.
   Google Scholar
• Willis BH, Coomar D, Baragilly M. Comparison of Centor and McIsaac scores in primary care: a meta-analysis over multiple thresholds. Br J Gen Pract. 2020;70(693):e245–e254.
   PubMed Web of Science ®Google Scholar
• Cheung L, Pattni V, Peacock P, et al. Throat swabs have no influence on the management of patients with sore throats. J Laryngol Otol. 2017;131(11):977–981.
   PubMed Web of Science ®Google Scholar
• Orda U, Biswadev M, Orda S, et al. Point of care testing for group A streptococci in patients presenting with pharyngitis will improve appropriate antibiotic prescription. Emerg Med Australas. 2016;28(2):199–204.
   PubMed Web of Science ®Google Scholar
• Orda U, Gunnarsson RK, Orda S, et al. Etiologic predictive value of a rapid immunoassay for detection of group A streptococci antigen from throat swabs on patients presenting with a sore throat. Int J Infect Dis. 2016;45:32–35.
   PubMed Web of Science ®Google Scholar
• Gunnarsson MS, Sundvall PD, Gunnarsson R. In primary health care, never prescribe antibiotics to patients suspected of having an uncomplicated sore throat caused by group A beta-haemolytic streptococci without first confirming the presence of this bacterium. Scand J Infect Dis. 2012;44(12):915–921.
   PubMed Web of Science ®Google Scholar
• Kenealy T. Sore throat. BMJ Clin Evid. 2007;2007:1509.
   Google Scholar
• Mantzourani E, Wasag D, Cannings-John R, et al. Characteristics of the sore throat test and treat service in community pharmacies (STREP) in Wales: cross-sectional analysis of 11 304 consultations using anonymized electronic pharmacy records. J Antimicrob Chemother. 2022;78(1):84–92.
   PubMed Web of Science ®Google Scholar
• Cohen JF, Pauchard JY, Hjelm N, et al. Efficacy and safety of rapid tests to guide antibiotic prescriptions for sore throat. Cochrane Database Syst Rev. 2020;6(6):CD012431.
   PubMedGoogle Scholar
• Gunnarsson RK, Orda U, Elliott B, et al. Improving antibiotics targeting using PCR point-of-care testing for group A streptococci in patients with uncomplicated acute sore throat. Aust J Gen Pract. 2021;50(1–2):745–753.
   Web of Science ®Google Scholar
• Fraser H, Gallacher D, Achana F, et al. Rapid antigen detection and molecular tests for group A streptococcal infections for acute sore throat: systematic reviews and economic evaluation. Health Technol Assess. 2020;24(31):1–232.
   Web of Science ®Google Scholar
• Health Technology Wales (HTW). Rapid antigen detection tests for group A streptococcal infections to treat people with a sore throat in the community pharmacy setting (Evidence Appraisal Report). 2020; p. 20. Available from: https://healthtechnology.wales/wp-content/uploads/2020/02/EAR020-Rapid-antigen-detecting-tests.pdf
   Google Scholar
• Health Technology Wales (HTW). Rapid antigen detection tests for group A streptococcal infections to treat people with a sore throat in the community pharmacy setting (HTW Guidance). 2020; p. 24. Available from: https://healthtechnology.wales/wp-content/uploads/2020/10/GUI020-Rapid-antigen-detecting-tests-English.pdf
   Google Scholar
• Klepser DG, Bisanz SE, Klepser ME. Cost-effectiveness of pharmacist-provided treatment of adult pharyngitis. Am J Manag Care. 2012;18(4):e145–e154.
   Google Scholar
• Andre M, Hedin K, Hakansson A, et al. More physician consultations and antibiotic prescriptions in families with high concern about infectious illness-adequate response to infection-prone child or self-fulfilling prophecy? Fam Pract. 2007;24(4):302–307.
   PubMed Web of Science ®Google Scholar
• OECD iLibrary. Health at a Glance: Europe 2020. State of health in the EU cycle. Paris: OECD Publishing; 2020.
   Google Scholar
• Tyrstrup M, van der Velden A, Engstrom S, et al. Antibiotic prescribing in relation to diagnoses and consultation rates in Belgium, The Netherlands and Sweden: use of European quality indicators. Scand J Prim Health Care. 2017;35(1):10–18.
   PubMed Web of Science ®Google Scholar
• Pitts J, Vincent S. What influences doctors’ prescribing? Sore throats revisited. J R Coll Gen Pract. 1989;39(319):65–66.
   PubMedGoogle Scholar
• Howie JG. Some non-bacteriological determinants and implications of antibiotic use in upper respiratory tract illness. Scand J Infect Dis Suppl. 1983;39:68–72.
   PubMedGoogle Scholar
• Coxeter P, Del Mar CB, McGregor L, et al. Interventions to facilitate shared decision making to address antibiotic use for acute respiratory infections in primary care. Cochrane Database Syst Rev. 2015;2015(11):CD010907.
   PubMedGoogle Scholar
• Little P, Moore M, Kelly J, PIPS Investigators, et al. Delayed antibiotic prescribing strategies for respiratory tract infections in primary care: pragmatic, factorial, randomised controlled trial. BMJ. 2014;348:g1606.
   PubMed Web of Science ®Google Scholar