FPs Need to Improve Testing, Treatment for Acute Pharyngitis

Many family physicians and pediatricians may overprescribe antibiotics for acute pharyngitis, according to a research report in the June issue of Pediatrics. Surveys completed by 525 AAFP members and 423 members of the American Academy of Pediatrics led to the findings of overprescription and other errors.

In "Clinicians' Management of Children and Adolescents With Acute Pharyngitis," the authors describe their survey, which posed questions about two scenarios involving acute pharyngitis and asked respondents to choose from among eight management strategies. In one scenario, a child had pharyngitis suggestive of group A Streptococcus; the other scenario portrayed a child with findings consistent with viral pharyngitis.

"Correctly distinguishing GAS (group A Streptococcus) is imperative to minimize the inappropriate use of antimicrobials, a critical step in reducing antimicrobial resistance," say the authors, led by pediatrician Sarah Park, M.D., of the Hawaii Department of Health/Disease Outbreak Control Division in Honolulu. Staff from the Academy's National Research Network participated in the study.

"Most physicians in our study reported using an appropriate strategy for managing children and adolescents with acute pharyngitis suggestive of GAS," say the authors. "However … 32 percent to 81 percent reported using inappropriate management strategies."

The wrong strategies included using empirical therapy without diagnostic testing, continuing antimicrobials despite negative test results, performing follow-up tests on asymptomatic children, and performing diagnostic tests on children with clinical and epidemiological findings consistent with viral pharyngitis.

"Such strategies could contribute to inappropriate antimicrobial use," say the authors.

Comparing FPs' and pediatricians' survey responses, the authors note, "Family physicians were significantly more likely than pediatricians (76 percent vs. 57 percent) to consider starting antimicrobials before learning test results. … Family physicians were more likely than pediatricians (90 percent vs. 58 percent) to admit that parent expectations might have an effect on their decision to provide antimicrobial treatment."

In addition, the FPs in the study were more likely than the pediatricians to be in rural settings and in solo or two-person practices, "independent factors associated with inappropriate strategies and settings that may have fewer resources," say the authors.

They recommend using standardized health care quality measures that focus on optimizing the use of diagnostic tests to help physicians improve their everyday practice strategies and better adhere to clinical guidelines. The authors also advise educational programs for residents and practicing physicians to counter the overuse of diagnostic tests and antimicrobial prescribing for children with a very low likelihood of having group A Streptococcus infection.