0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Position Papers |

Principles of Appropriate Antibiotic Use for Acute Pharyngitis in Adults: Background

Richelle J. Cooper, MD, MSHS; Jerome R. Hoffman, MA, MD; John G. Bartlett, MD; Richard E. Besser, MD; Ralph Gonzales, MD, MSPH; John M. Hickner, MD, MSc; and Merle A. Sande, MD
[+] Article and Author Information

From University of California, Los Angeles, Los Angeles, California; Johns Hopkins University, Baltimore, Maryland; Centers for Disease Control and Prevention, Atlanta, Georgia; University of Colorado Health Sciences Center, Denver, Colorado; Michigan State University, East Lansing, Michigan; and University of Utah, Salt Lake City, Utah.


*After the primary authors (Drs. Cooper and Hoffman), authors are listed in alphabetical order.

In addition to the Centers for Disease Control and Prevention, the principles outlined in this document have been endorsed by the American Academy of Family Physicians and the American College of Physicians–American Society of Internal Medicine.

Annals of Internal Medicine encourages readers to copy and distribute this paper, providing such distribution is not for profit. Commercial distribution is not permitted without the express permission of the publisher.

Acknowledgments: External review has included feedback from the Centers for Disease Control and Prevention; the Clinical Efficacy Assessment Subcommittee; and representatives of the American Academy of Family Practitioners, the American College of Emergency Physicians, and the Infectious Diseases Society of America. Feedback was also provided by Paul Little, MD, an expert in pharyngitis treatment, as well as full-time practicing physicians.

Role of the Funding Sources: The Centers for Disease Control and Prevention provided partial support for the development of the principles and required final approval of all manuscripts submitted for publication. Dr. Cooper is supported in part by a National Research Service Award (F32 HS00134-01) from the Agency for Healthcare Research and Quality.

Requests for Single Reprints: Richard E. Besser, MD, Respiratory Diseases Branch (C-23), Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333; e-mail, rbesser0@cdc.gov.

Current Author Addresses: Drs. Cooper and Hoffman: University of California, Los Angeles, Emergency Medicine Center, 924 Westwood Boulevard, Suite 300, Los Angeles, CA 90024.

Dr. Bartlett: Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 463A, Baltimore, MD 21287-0003.

Dr. Besser: Respiratory Diseases Branch (C-23), Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333.

Dr. Gonzales: Division of General Internal Medicine, Campus Box B-180, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Denver, CO 80262.

Dr. Hickner: B111 Clinical Center, Michigan State University Department of Family Practice, East Lansing, MI 48824.

Dr. Sande: Department of Medicine (4C104), University of Utah, 50 North Medical Drive, Salt Lake City, UT 84132.


Ann Intern Med. 2001;134(6):509-517. doi:10.7326/0003-4819-134-6-200103200-00019
Text Size: A A A

The following principles of appropriate antibiotic use for adults with acute pharyngitis apply to immunocompetent adults without complicated comorbid conditions, such as chronic lung or heart disease, and history of rheumatic fever. They do not apply during known outbreaks of group A streptococcus.

1. Group A β-hemolytic streptococcus (GABHS) is the causal agent in approximately 10% of adult cases of pharyngitis. The large majority of adults with acute pharyngitis have a self-limited illness, for which supportive care only is needed.

2. Antibiotic treatment of adult pharyngitis benefits only those patients with GABHS infection. All patients with pharyngitis should be offered appropriate doses of analgesics and antipyretics, as well as other supportive care.

3. Limit antibiotic prescriptions to patients who are most likely to have GABHS infection. Clinically screen all adult patients with pharyngitis for the presence of the four Centor criteria: history of fever, tonsillar exudates, no cough, and tender anterior cervical lymphadenopathy [lymphadenitis]. Do not test or treat patients with none or only one of these criteria, since these patients are unlikely to have GABHS infection. For patients with two or more criteria the following strategies are appropriate: a) Test patients with two, three, or four criteria by using a rapid antigen test, and limit antibiotic therapy to patients with positive test results; b] test patients with two or three criteria by using a rapid antigen test, and limit antibiotic therapy to patients with positive test results or patients with four criteria; or c) do not use any diagnostic tests, and limit antibiotic therapy to patients with three or four criteria.

4. Throat cultures are not recommended for the routine primary evaluation of adults with pharyngitis or for confirmation of negative results on rapid antigen tests when the test sensitivity exceeds 80%. Throat cultures may be indicated as part of investigations of outbreaks of GABHS disease, for monitoring the development and spread of antibiotic resistance, or when such pathogens as gonococcus are being considered.

5. The preferred antibiotic for treatment of acute GABHS pharyngitis is penicillin, or erythromycin in a penicillin-allergic patient.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)