Moderate and severe pharyngitis in young adult inhabitants of Poznan, western Poland

Abstract

Background. acute pharyngitis is a frequent clinical problem. Objectives. To assess: the frequency of streptococcal etiology (β-hs) in moderate to severe pharyngitis among young adult patients, the accuracy of the centor score (cs) in predicting the likelihood of the β-hs etiology and the usefulness of the rapid antigen detection test (radT) in the appropriate selection of patients that ought to be treated with antibiotics. Material and methods. 202 individuals (101 patients and a sex-and age-matched control group) aged 18-44 participated in the study. Two throat swabs were performed: the first one to carry out radT for group a streptococci (gas), and the second one to grow a conventional culture. data on the antibiotic therapy were recorded as well. Results. β-hs were responsible for one-third of the studied cases of pharyngitis (gas -22.8%, 23/101; high non-gas colony count -9.9%, 10/101). The frequency of the isolation of β-hs depending upon the cs was as follows: cs2 -13.2% (5/36), cs3 -40.5% (15/36), cs4 -61.5% (16/36). radT's effectiveness in identifying gas was significantly higher than that of cs alone (p < 0.001). antibiotics were prescribed in 59 cases, including 45% of radT-negative patients (35/77). The primary choice was penicillin (37.3%, 22/59). Conclusions. in young adult pharyngitis patients with cs2-4, β-hs are responsible for a minority of cases. among these bacteria, almost one third are non-gas. centor criteria, as the only diagnostic tool in predicting the streptococcal etiology of the disease, are of moderate usefulness. The use of radT significantly increases the diagnostic accuracy of gas-related pharyngitis. Key words: streptococci, pharyngitis, gas, radT, non-gas, centor score.

Modalities of group A streptococcal prevention and treatment and their economic justification

“…All the studies on managing pharyngitis were conducted in upper-middle or high-income countries. One study evaluated treatment choice 18 and five evaluated diagnostic strategy 19 – 23 . Four of the five studies that evaluated diagnostic strategies concluded that routine use of rapid antigen detection tests (RADTs) resulted in the lowest cost per case of accurate diagnosis and antibiotic treatment 19 – 22 .…”

“…One study evaluated treatment choice 18 and five evaluated diagnostic strategy 19 – 23 . Four of the five studies that evaluated diagnostic strategies concluded that routine use of rapid antigen detection tests (RADTs) resulted in the lowest cost per case of accurate diagnosis and antibiotic treatment 19 – 22 . The other study evaluated backup testing for negative RADTs, concluding that it was of limited value 23 .…”