Reconsidering sore throats. Part 2: Alternative approach and practical office tool.

OBJECTIVE: To identify a management approach for Group A streptococcal (GAS) pharyngitis that would address overuse of antibiotics and could be implemented immediately.

QUALITY OF EVIDENCE: No randomized, controlled trials were found; four observational studies met our criteria: simplicity, discrimination ability for GAS pharyngitis compared with throat culture, and validation in a different patient population. Only one scoring system fulfilled all three criteria.

MAIN FINDINGS: Formal clinical scoring systems have the potential to improve family physicians' ability to identify and manage GAS pharyngitis. One system had been sufficiently validated to support its use in clinical practice. Four clinical characteristics (no cough, fever higher than 38 degrees C, exudate, and tender cervical nodes) linked to explicit management decisions form the basis for a sore throat score.

CONCLUSIONS: Use of a clinical score for management of GAS pharyngitis can be recommended on the basis of the rarity of rheumatic fever in modern society, the resources devoted to management of upper respiratory tract illnesses, the volume of antibiotics prescribed, and the emergence of antibiotic resistance as a growing health issue.