Improving pediatric emergency department physicians’ adherence to clinical practice guidelines on the diagnosis and management of group A beta-hemolytic streptococcal pharyngitis—a cross-sectional study

Abstract

IntroductionPharyngitis is one of the major and commonly seen presentations in pediatric emergency departments. While it could be caused by both bacterial and viral pathogens, antibiotics are improperly prescribed regardless of the pathogen. Inappropriate usage of antibiotics has risen the concern of microbial resistance and the need for stricter guidelines. Many guidelines have been validated for this reason, and the Centor score (Modified/McIsaac) is most commonly implemented. This study aims to assess the adherence and enumerate the reasons behind the suboptimal adherence to guidelines (Centor/McIsaac score) of pediatric emergency department physicians in the diagnosis and management of GABHS pharyngitis to lay the groundwork for future actions and to employ educational programs and implement local guidelines for the prevention of the development of multi-drug resistant microorganisms.MethodologyWe surveyed pediatric emergency department physicians of ten teaching hospitals of Riyadh, Saudi Arabia. We used convenient sampling and estimated a sample size of 170 physicians, and interns and medical centers without pediatric emergency department were excluded from the study. Elements of the Centor score (Modified/McIsaac) were used as a part of the assessment of physicians’ knowledge of the guidelines. Adherence was assessed by requiring the participants to answer questions regarding their usage of diagnostic means when they suspect a bacterial cause of pharyngitis, as recommended by the guidelines.ResultsA total of 243 physicians answered the questionnaire, 43 consultants (17.6%) and 200 non-consultants (82.4%). On the knowledge score, 9.1% scored 0, and the majority of both groups, 46.5%, earned a score of 1. The remainder 44.4%, earned a score of 2. Adherence to guidelines was defined as when diagnostic tests (throat culture or rapid antigen detection test) were always requested prior to prescribing antibiotics when acute bacterial pharyngitis was suspected. Only 27.3% (n = 67) of our sample are adherent to guidelines, whereas the majority, 72.7% (n = 175), are non-adherent. Several factors were assessed as reasons for lack of adherence.ConclusionLack of knowledge and adherence to guidelines is prevalent in our setting, with awareness, knowledge, and behavior of physicians playing as major factors behind this low adherence. Studies should aim towards the assessment of adherence towards locally developed guidelines.

Knowledge, Attitude, and Practice of House Officers to the Diagnosis and Management of Bacterial Pharyngitis: A Multicenter Cross-Sectional Study

“…Only 20.7% of the participants in our study were adherent to the use of benzathine penicillin G as the first-line management of bacterial pharyngitis. This is similar to another study that had an adherence rate of 27.7% [ 20 ]. This is also less than that in another study, which had an adherence rate of 34% [ 21 ].…”

“…This was followed by difficulties in ensuring proper follow-up of patients and parental pressure to prescribe antibiotics, respectively. The unavailability of diagnostic tests is the least of all factors behind suboptimal adherence [ 20 ].…”

“…Antibiotics are improperly prescribed by doctors to treat patients with a sore throat, regardless of the causative agent. Improper use of antibiotics raises concerns about microbial resistance and emphasizes the need for clear diagnostic clinical guidelines [ 20 ].…”