Principles of Appropriate Antibiotic Use for Acute Pharyngitis in Adults
- Vincenza Snow, MD;
- Christel Mottur-Pilson, PhD;
- Richelle J. Cooper, MD, MSHS;
- Jerome R. Hoffman, MD, MA; and
- for the American College of Physicians–American Society of Internal Medicine*
CLINICAL PRACTICE GUIDELINE, PART 1
In this guideline, we present the evidence and make specific recommendations on how clinicians can distinguish and diagnose pharyngitis caused by group A β-hemolytic streptococcus (GABHS). We also discuss when antibiotic use is beneficial and which antibiotics should be used. This guideline will not cover gonococcal pharyngitis and diphtheria, for which the appropriateness of immediate antibiotic treatment is well established. The numbers in square brackets are cross-references to the numbered sections in the accompanying background paper, “Principles of Appropriate Antibiotic Use for Acute Pharyngitis in Adults: Background,” which is part 2 of this guideline (see pages 509-517).
Acute Pharyngitis
Acute pharyngitis accounts for 1% to 2% of all visits to outpatient departments, physician offices and emergency departments. A wide range of infectious agents produces acute pharyngitis, but viruses are the most common cause. Approximately 5% to 15% of adult cases are caused by GABHS. In some patients, it can be important to identify an infectious cause other than GABHS (for example, gonococcal pharyngitis, Epstein–Barr virus, and acute HIV infection), but in the vast majority of cases, acute pharyngitis in an otherwise healthy adult is self-limited and rarely produces significant sequelae [1.1].
Antimicrobial agents are prescribed to a substantial majority of patients with acute pharyngitis because of perceived patient expectations or physician desires to avoid such potential complications as rheumatic fever and acute glomerulonephritis. Consequently, this discussion will focus on the diagnosis and treatment of acute GABHS pharyngitis in adult patients. These guidelines do not apply to patients with a history of rheumatic fever, valvular heart disease, immunosuppression, or recurrent or chronic pharyngitis (symptoms > 7 days) or to patients whose sore throats are not due to acute pharyngitis. They are also not intended to apply during a known epidemic of acute rheumatic fever or streptococcal …
This 100-word excerpt has been provided in the absence of an abstract.
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