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AIM: To describe the sore throat management practices by New Zealand general practitioners (GPs) and compare the rate of sore throat presentation over time. METHOD: Data were collected from the National Primary Medical Care Survey carried out over 2001/2002. Analyses were done on patients who presented to the GP with the symptom of a sore throat as one of their reasons for visit. A systematic review of the New Zealand literature was done for sore throat presentation to GPs since 1966. RESULTS: There were 10,506 records of visits gathered from 246 GPs and 335 patients presented sore throat as a reason for visit. Patients presented sore throat at a rate (SE) of 3.6 (0.26) per 100 encounters and varied by age (p=0.004), but not by socioeconomic deprivation (p=0.415) or by ethnic group (p=0.165). Patients' perceived urgency of visit had a greater impact in the rate of presentation for the 0-4 year age group than in the at-risk age group of 5-14 years (p=0.001). GPs recorded a 'Read code' diagnosis at a rate of 59.2 (3.96) recordings per 100 encounters. Among the 306 recorded diagnoses, 11.4% were explicit recordings of viral diagnoses. 7.6% of GPs ranked themselves as 'moderately' and 2.3% as 'highly' uncertain of their diagnosis. Throats swabs were taken at a rate of 6.6 (1.68) swabs per 100 encounters. Antibiotic prescribing rate was higher when sore throat was recorded as a reason for visit than not (p<0.001). There were no significant differences in throat swabs taken for sore throat patients prescribed an antibiotic or not (p=0.623). No Pacific person had a throat swab taken. Patients with sore throat who were Maori (73.5 [7.2]) or Pacific people (80.2 [17.3]) were more likely to be prescribed an antibiotic than Europeans (57.4 [4.62]). Since 1966, there were 16 New Zealand studies of patients presenting with respiratory disorders to their GP. Seven of these studies measured GP management of sore throat, and only 3 of these measured the rate of patients' sore throat symptom presentation. The rate of patients' sore throat presentation remained similar when compared with the Waikato study of 1991 (2.8%) that had a similar methodology. CONCLUSION: Sore throat continues to be a common symptom that GPs manage in their work. Ethnic differences may have a part to play in how GPs manage sore throat. More research is needed to discover those factors that would encourage a greater proportion at-risk 5-14 year old children to attend their GP with sore throat.
OBJECTIVE: To compare cultures throat swab after physiotherapy with results of sputum culture in identification of lower airway pathogens in children with cystic fibrosis. METHODS: 387 samples of sputum cough swabs, throat swab and throat swab after physiotherapy were collected from 48 patients of cystic fibrosis and cultured for aerobic bacteria. The results of cultures of cough swabs, throat swab and throat swab after physiotherapy were compared with results of sputum culture. RESULTS: There was good concordance between culture results of sputum and other methods. Over all concordance was 70%, 81% and 92% with cough swab, throat swab and throat swab after physiotherapy. Sensitivity for isolation of Pseudomonas aeruginosa by throat swab, cough swab and throat swab after physiotherapy was 40%, 42% and 82% respectively. Specificity for isolation of Pseudomonas by throat swab, cough swab and throat swab after physiotherapy was 99%, 100% and 99% respectively. Sensitivity for isolation of Staphylococcus aureus by throat swab, cough swab and throat swab after physiotherapy was 57%, 50% and 100% respectively. Specificity for isolation of Staphylococcus by throat swab, cough swab and throat swab after physiotherapy was 99% for all these methods. CONCLUSION: It is concluded that throat swab after physiotherapy in a child with CF can be used reliably for identification of lower airway pathogens.
BACKGROUND AND STUDY AIMS: The use of sedation in upper gastrointestinal endoscopy is widespread, mainly because of the belief that patients are likely to tolerate the procedure better. The aim of the present study was to assess patients' response to the policy of actively persuading them to accept a throat spray for upper gastrointestinal endoscopy. PATIENTS AND METHODS: Three hundred patients who had recently undergone endoscopy were sent a questionnaire; 244 of them responded (81%). Data on age, sex, procedure tolerance, anxiety levels, and future choice of sedation or throat spray for repeat procedures were sought. The results were analysed using the chi-squared test. RESULTS: One hundred and ninety-two (79%) chose, or were persuaded to have, throat spray, and only nine (5%) had to be transferred to sedation. Thirty-two percent of patients who had throat spray tolerated endoscopy well, compared to 70% of those who chose sedation. One hundred and nineteen throat spray patients (62%) showed a low level of reluctance to undergo repeat endoscopy, compared to 37 (71%) sedated patients (not significant). One hundred and forty-four throat spray patients (76%) expressed satisfaction with the throat spray, but if given a choice, only 124 (66%) would choose throat spray again. Male patients, those with lower anxiety levels, and those over 50 years old, tolerated endoscopy with throat spray better, showed less reluctance to undergo repeat endoscopy, and were more likely to choose throat spray again. Those who had any previous experience of endoscopy under sedation were less likely to choose throat spray again. CONCLUSION: The present study shows that the use of throat spray for diagnostic endoscopy is quite acceptable to patients. For safety reasons, we should be encouraging greater use of throat spray in routine diagnostic upper gastrointestinal endoscopy.
AIMS: To compare the characteristics of sore throat patients with their having normal throat, to measure the incidence of beta-haemolytic streptococcal growth in both groups, and to determine the clinical outcomes of treating sore throat patients without the aid of a throat swab. METHOD: Patients were from a suburban general practice. A three phased prospective study of consecutive patients with sore throats as their primary complaint, or with normal throats. RESULTS: Patients presented with a sore throat at a rate of 45 per 1000 consultations and those with normal throats presented at a rate of 379 per 1000 consultations. 43% of normal throat patients were male compared to 34% with sore throat (chi 2 = 4.62, p < 0.02). The incidence of beta-haemolytic streptococcal growth in sore throat patients was 123 per 1000 consultations per year. 23% of people 14 years and younger had a positive growth compared to 9% of people over 14 years of age. (chi 2 = 5.04, df = 1, p < 0.05). The sore throat presentation peaked over the late autumn to early winter months (June-July) but the beta-haemolytic streptococcal infection rate remained low throughout the year. A history of pain for less than three days and fever, and on examination large neck glands and pus on the tonsils were all positive clinical features for beta-haemolytic streptococcal infection. However use of clinical criteria alone meant 73% of patients with no beta-haemolytic streptococcal infection were falsely treated. CONCLUSION: Research is needed to develop guidelines for the management of sore throats in general practice.
OBJECTIVE: To investigate the safety and efficacy of Throat Coat) (Traditional Medicinals,) Sebastopol, CA), a traditional demulcent herbal tea, in comparison with a placebo tea in the symptomatic treatment of acute pharyngitis. DESIGN: Multicenter, prospective, randomized, double-blinded, placebo-controlled, two-armed, parallel-group clinical trial. SETTINGS: Three primary care clinics in Duluth, MN, Madison, WI, and Middleton, WI. SUBJECTS: Patients of both genders (>or=18 years of age) with clinical diagnoses of acute pharyngitis. INTERVENTIONS: Patients (n = 60) were randomly assigned to receive 5-8 oz of Throat Coat (n = 30) or a placebo (n = 30), four to six times daily. The study period was 2 to 7 days with a window for the follow-up visit of 2-10 days accounting for the variable duration of sore throat symptoms. OUTCOME MEASURES: Primary efficacy parameter: sum of pain intensity differences (SPID) for pain in throat on swallowing, calculated as the area under the curve (AUC) of pain intensity difference scores (assessed at 1 minute, 5 minutes, 10 minutes, 15 minutes, 20 minutes, and 30 minutes after treatment). Secondary efficacy parameter: total pain relief (TOTPAR), calculated as the AUC from time 0 (baseline) to 30 minutes of pain relief (assessed at 1 minute, 5 minutes, 10 minutes, 15 minutes, 20 minutes, and 30 minutes). RESULTS: Compared to placebo, intensity of throat pain when swallowing was significantly reduced by Throat Coat in intention to treat and valid for efficacy analysis (VEA). Significant differences in change from baseline pain were observed at 5 min (p = 0.007), 10 min (p = 0.005), 15 minutes (p = 0.01), 20 minutes (p = 0.05), and 30 minutes (p = 0.04) after completion of the first dose (VEA analysis). There was a statistically significant improvement of SPID in the Throat Coat-treated group: Least square means +/- standard error of the means (SEM) of SPID were -16.5 +/- 13.9 in the placebo group and -43.8 +/- 11.9 in the Throat Coat-treated group (p = 0.012). TOTPAR was also significantly higher in the Throat Coat-treated group: Least square means +/- SEM of TOTPAR were 32.4 +/- 12.8 in the placebo group and 53.6 +/- 10.9 in the Throat Coat-treated group (p = 0.031). This study shows that Throat Coat is significantly superior to placebo and provided a rapid, temporary relief of sore throat pain in patients with pharyngitis.
UNLABELLED: Organisms colonizing the oropharynx of patients in the intensive care unit (ICU) play an important role in the development of nosocomial infection. Thus, routine throat swab specimens of ICU patients are recommended to screen for potential pathogens [20]. This investigation was designed to clarify the value of throat swabs taken in addition to tracheal aspirates, urine cultures, and wound swabs with regard to antibiotic therapy in patients with pneumonia and other infections. MATERIALS AND METHODS. A total 627 intubated patients were examined in a surgical ICU during a 12 month period. Pharyngeal swabs, tracheal aspirates, urine cultures, and-if necessary-swabs from wounds and drains were taken immediately after admission to the ICU and routinely thereafter three times each week. DEFINITIONS: Early onset pneumonia: pneumonia occurring within 4 days; late onset pneumonia: pneumonia occurring after the 4th day. Intra-abdominal infection: diffuse or localized peritonitis or abdominal abscess. Wound infection: soft-tissue or bone infection. Corresponding organisms: the same species of bacteria with the same sensitivity pattern (Table 1). RESULTS. Sixty-eight of the patients developed pneumonia. 37 had early onset pneumonia. In 22 of these patients, throat and tracheal specimens had been obtained 2-3 days before the pneumonia was diagnosed. In these specimens, the causative organisms for the subsequent pneumonia were isolated in the throat in 60% of cases and in tracheal secretions in 40% (Table 3). In 35 patients with late onset pneumonia, the causative bacteria were found in 66% of the cases in the throat swabs obtained 2-3 days before the diagnosis was made, in tracheal aspirates in 74% (Table 4). Throat swabs obtained at admission to the ICU from already infected patients or from patients who developed an infection were significantly more colonized with potentially pathogenic micro-organisms (Fig. 1). In 4 patients with early onset pneumonia the results of the throat swab cultures influenced antibiotic therapy, but none of the throat culture results influenced the therapy of the patients with late onset pneumonia or other infections (intra-abdominal infection, wound infection, urinary tract infection). CONCLUSIONS. The throat swab taken at admission may indicate patients at risk for infection. However, throat cultures taken routinely thereafter, parallel with tracheal aspirate cultures, do not provide additional information that is diagnostically or therapeutically helpful. Therefore, throat swab cultures are not necessary for routine bacteriological monitoring. For the prevention of colonization by local administration of antimicrobial agents, regular throat cultures are mandatory.
CONTEXT: Sore throat is a common complaint, and identifying patients with group A beta-hemolytic streptococcal pharyngitis (strep throat) is an important task for clinicians. Previous reviews have not systematically reviewed and synthesized the evidence. OBJECTIVE: To review the precision and accuracy of the clinical examination in diagnosing strep throat. DATA SOURCE: MEDLINE search for articles about diagnosis of strep throat using history-taking and physical examination. STUDY SELECTION: Large blinded, prospective studies (having > or =300 patients with sore throat) reporting history and physical examination data and using throat culture as the reference standard were included. Of 917 articles identified by the search, 9 met all inclusion criteria. DATA EXTRACTION: Pairs of authors independently reviewed each article and used consensus to resolve discrepancies. DATA SYNTHESIS: The most useful findings for evaluating the likelihood of strep throat are presence of tonsillar exudate, pharyngeal exudate, or exposure to strep throat infection in the previous 2 weeks (positive likelihood ratios, 3.4, 2.1, and 1.9, respectively) and the absence of tender anterior cervical nodes, tonsillar enlargement, or exudate (negative likelihood ratios, 0.60, 0.63, and 0.74, respectively). No individual element of history-taking or physical examination is accurate enough by itself to rule in or rule out strep throat. Three validated clinical prediction rules are described for adult and pediatric populations. CONCLUSIONS: While no single element of history-taking or physical examination is sufficiently accurate to exclude or diagnose strep throat, a well-validated clinical prediction rule can be useful and can help physicians make more informed use of rapid antigen tests and throat cultures.
BACKGROUND: Sore throat is a very common reason for people to seek medical care. It is a disease that remits spontaneously, that is, 'cure' is not dependent on treatment. Nonetheless primary care doctors commonly prescribe antibiotics for sore throat and other upper respiratory tract infections. OBJECTIVES: To assess the benefits of antibiotics in the management of sore throat. SEARCH STRATEGY: Systematic search of the literature from 1945 to 2003, using electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, issue 2, 2003); MEDLINE (January 1966 to May 2003); EMBASE (January 1990 to March 2003), and the reference sections of the articles identified. We applied no language restrictions. We used abstracts of identified articles to identify trials. SELECTION CRITERIA: Trials of antibiotic against control with either measures of the typical symptoms (throat soreness, headache or fever), or suppurative complications (meaning: forming pus) and non-suppurative complications of sore throat. DATA COLLECTION AND ANALYSIS: Two reviewers independently screened potential studies for inclusion and resolved differences in opinion by discussion. The reviewers then independently extracted the data from the selected studies. We contacted the authors of three studies to acquire additional information not available in published articles. Potential studies were screened independently by two reviewers for inclusion, with differences in opinion resolved by discussion. Data was then independently extracted from studies selected by inclusion by two reviewers. Authors of three studies were contacted to acquire additional information not available in published articles. MAIN RESULTS: We included twenty-six studies, covering 12,669 cases of sore throat in the review.1. Non-suppurative complications There was a trend for protection against acute glomerulonephritis by antibiotics, but insufficient cases were recorded to be sure of this effect. Several studies found that antibiotics reduced acute rheumatic fever, to less than one third (odds ratio (OR) = 0.30; 95% confidence interval (CI) = 0.20 to 0.45). 2. Suppurative complications Antibiotics reduced the incidence of acute otitis media to about one quarter of that in the placebo group (OR = 0.22; 95% CI 0.11 to 0.43) and reduced the incidence of acute sinusitis to about one half of that in the placebo group (OR = 0.46; 95% CI 0.10 to 2.05). The incidence of quinsy was also reduced in relation to placebo group (OR = 0.16; 95% CI 0.07 to 0.35). 3. Symptoms Symptoms of headache, throat soreness and fever were reduced by antibiotics to about one half. The greatest time for this to be evident was at about three and a half days (when the symptoms of about 50% of untreated patients had settled). About 90% of treated and untreated patients were free of symptoms by one week. The overall number needed to treat to prevent one sore throat at day three was about 5.0 (95% CI 4.5 to 5.8); and at one week was 14.2 (95% CI 11.5 to 20.6). 4. Subgroup analyses of symptom reduction Subgroup analysis by age; blind versus unblinded; or use of antipyretics yielded no significant differences. The results of swabs of the throat for Streptococcus influenced the effect of antibiotics. If the swab was positive, antibiotics were more effective (the OR reduced to 0.16, 95% CI 0.09 to 0.26) than if it was negative (OR 0.65; 95% CI 0.38 to 1.12). REVIEWERS' CONCLUSIONS: Antibiotics confer relative benefits in the treatment of sore throat. However, the absolute benefits are modest. Protecting sore throat sufferers against suppurative and non-suppurative complications in modern Western society can be achieved only by treating with antibiotics many who will derive no benefit. In emerging economies where rates of for example acute rheumatic fever are high, the number needed to treat may be much lower. Antibiotics shorten the duration of symptoms by a mean of one day about half way through the illness (the time of maximal effect), and by about sixteen hours overall.
The aim of this study was to investigate the applicability of replacing the glass throat from a twin-stage impinger (TSI) with a human oral-throat cast. Monodisperse aerosols were used to calibrate the human oral cast-TSI at 60 L min(-1) and cut-off in particle size was compared with that of the TSI described in the British Pharmacopoeia which employs a glass throat. The amount of salbutamol sulphate (and lactose) delivered by the Cyclohaler depositing on various elements of the in-vitro model were determined. The calibration of the model containing a human oral-throat cast at 60 L min(-1) gave a particle size cut-off of 5.2 microm which was less than that of the TSI (6.3 microm). The oral-throat cast trapped more drug than the glass throat model with a formulation that employed the larger carrier (63-90 microm; P<0.05) while it trapped a lesser amount of drug with those filled with the lower size carrier (Lactochem, micronised lactose). The greater amount of lactose in the formulation that employed the larger-sized carrier (63-90 microm) was deposited closer to the inlet of the oral-throat cast than to the inlet of the glass throat model. Replacement of the glass throat in the TSI by the human oral-throat cast, leads to a change in deposition efficiency, with the cast having a higher filter efficiency and hence more aerosol particles being captured before their entry into the TSI. This should be investigated further to determine whether such a model might provide a more realistic assessment of the in-vivo characteristics of an aerosol in comparison with the TSI currently being employed, which utilises the glass throat as the portal of entry.
Nasal challenge with bradykinin has been previously reported to cause sore throat. The aim of the present study was to investigate the mechanism of sore throat by comparing the effects of nasal and oropharyngeal challenge with bradykinin on the sensation of sore throat. Twelve healthy volunteers (6 male, 6 female, mean age 29.9 years), were given nasal followed by oropharyngeal challenge with bradykinin. The nasal and oropharyngeal challenges were separated by 1 week and 1 mg of bradykinin dissolved in 10% ethanol in 0.9% saline was administered as a spray to both nasal passages or to the posterior oropharyngeal wall and tonsillar fauces. The same group of volunteers were also given a control nasal challenge with the ethanol/saline vehicle. Subjects were asked to score symptoms of throat irritation using a ten point visual analogue scale with the extremes labelled 'Worst ever throat irritation' and 'No throat irritation', before and at intervals after bradykinin challenge. Nasal challenge with vehicle did not cause any throat irritation, but both nasal and oropharyngeal challenge with bradykinin caused a significant increase in throat irritation scores at 5 and 15 min following challenge when compared with baseline scores. At 30 min following challenge, the throat irritation scores obtained on nasal challenge were significantly greater than those obtained on oropharyngeal challenge. The results demonstrate that nasal challenge with bradykinin causes a sensation of sore throat which is just as intense as that caused by oropharyngeal challenge and with the sensation of sore throat persisting for a longer period on nasal challenge when compared with oropharyngeal challenge.(ABSTRACT TRUNCATED AT 250 WORDS)
The purpose of our study was to investigate the suitability of throat gargling with sterile saline as an alternative method to throat swabs for detection of group A beta- hemolytic streptococcus (GAS). Throat specimens were obtained from 601 cases belonging to different age groups. Sterile Dacron swabs and gargle residue were first streaked on the side of a 5% sheep blood agar plate to which a 0.04 U bacitracin disk had been applied, and then 1.25 mg trimethoprim and 23.75 mg sulphamethoxazole were added to the plate. After incubation, beta-hemolytic colonies were classified serologically by latex agglutination. GAS was detected in both throat swabs and throat gargle specimens in 49 cases, but GAS was also detected in 12 throat swabs from patients with culture-negative gargles and in 8 gargle specimens from subjects in whom throat swabs were culture negative. The strength of agreement was evaluated by calculating the kappa coefficient (K = 0.82, P = 0.000). The sensitivity, specificity, positive predictive value, and negative predictive value of throat gargle specimens were 80.3, 98.5, 85.9, and 97.8%, respectively. Although the conventional throat swab culture remains the gold standard, the throat gargle method is a quick, safe, and easy method for detection of GAS that serves as an effective alternative to throat swab culture.
BACKGROUND: Sore throat is a very common reason for people to present for medical care. Although it remits spontaneously, primary care doctors commonly prescribe antibiotics for it. OBJECTIVES: To assess the benefits of antibiotics for sore throat. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library, Issue 1, 2006), MEDLINE (January 1966 to March 2006) and EMBASE (January 1990 to December 2005). SELECTION CRITERIA: Trials of antibiotic against control with either measures of the typical symptoms (throat soreness, headache or fever), or suppurative or non-suppurative complications of sore throat. DATA COLLECTION AND ANALYSIS: Potential studies were screened independently by two authors for inclusion, with differences in opinion resolved by discussion. Data were then independently extracted from studies selected by inclusion by two authors. Researchers from three studies were contacted for additional information. MAIN RESULTS: There were 27 studies with 2835 cases of sore throat. 1. Non-suppurative complications: There was a trend for antibiotics to protect against acute glomerulonephritis, but there were insufficient cases to be sure. Several studies found antibiotics reduced acute rheumatic fever by more than two thirds (relative risk (RR) 0.22; 95% CI 0.02 to 2.08). 2. Suppurative complications: Antibiotics reduced the incidence of acute otitis media (RR 0.30; 95% CI 0.15 to 0.58); of acute sinusitis (RR 0.48; 95% CI 0.08 to 2.76); and of quinsy (peritonsillar abscess) compared to those taking placebo (RR 0.15; 95% CI 0.05 to 0.47). 3. SYMPTOMS: Throat soreness and fever were reduced by antibiotics by about one half. The greatest difference was seen at about 3 to 4 days (when the symptoms of about 50% of untreated patients had settled). By one week about 90% of treated and untreated patients were symptom-free. The overall number need to treat to prevent one sore throat at day 3 was just under six (95% CI 4.9 to 7.0); at week 1 it was 21 (95% CI 13.2 to 47.9). 4. Subgroup analyses of symptom reduction: Analysis by: age; blind versus unblinded; or use of antipyretics, found no significant differences. Analysis of results of throat swabs showed that antibiotics were more effective against symptoms at day 3, RR 0.58 (95% CI 0.48 to 0.71) if the swabs were positive for Streptococcus, compared to RR 0.78 (95% CI 0.63 to 0.97) if negative. Similarly at week 1, RRs 0.29 (95% CI 0.12 to 0.70) for positive, and 0.73 (95% CI 0.50 to 1.07) for negative swabs. AUTHORS' CONCLUSIONS: Antibiotics confer relative benefits in the treatment of sore throat. However, the absolute benefits are modest. Protecting sore throat sufferers against suppurative and non-suppurative complications in modern Western society can only be achieved by treating many with antibiotics, most of whom will derive no benefit. In emerging economies (where rates of acute rheumatic fever are high, for example), the number needed to treat may be much lower for antibiotics to be considered effective. Antibiotics shorten the duration of symptoms by about sixteen hours overall.
OBJECTIVE: To assess the medicalising effect of prescribing antibiotics for sore throat. SETTING: 11 general practices in England. DESIGN: Randomised trial of three approaches to sore throat: a 10 day prescription of antibiotics, no antibiotics, or a delayed prescription if the sore throat had not started to settle after three days. PATIENTS: 716 patients aged 4 and over with sore throat and an abnormal physical sign: 84% had tonsillitis or pharyngitis. OUTCOME MEASURES: Number and rate of patients making a first return with sore throat, pharyngitis, or tonsillitis. Early returns (within two weeks) and complications (otitis media, sinusitis, quinsy). Outcomes were documented in 675 subjects (94%). RESULTS: Mean follow up time was similar (antibiotic group 1.07 years, other two groups 1.03 years). More of those initially prescribed antibiotics initially returned to the surgery with sore throat (38% v 27%, adjusted hazard ratio for return 1.39%, 95% confidence interval 1.03 to 1.89). Antibiotics prescribed for sore throat during the previous year had an additional effect (hazard ratio 1.69, 1.20 to 2.37). Longer duration of illness (> 5 days) was associated with increased return within six weeks (hazard ratio 2.90, 1.70 to 4.92). Prior attendance with upper respiratory conditions was also associated with increased reattendance. There was no difference between groups in early return (13/238 (5.5%) v 27/437 (6%)), or complications (2/236 (0.8%) v 3/434 (0.7%)). CONCLUSIONS: Complications and early return resulting from no or delayed prescribing of antibiotics for sore throat are rare. Both current and previous prescribing for sore throat increase reattendance. To avoid medicalising a self limiting illness doctors should avoid antibiotics or offer a delayed prescription for most patients with sore throat.
Despite its imperfections, the throat culture remains the "gold standard" against which all rapid streptococcal antigen detection tests are compared. Using triple throat swabs, the accuracy of a rapid latex agglutination (LA) test and back up throat culture was determined and compared with a simultaneously obtained additional throat culture in children with suspected streptococcal pharyngitis. Although there was a 95 percent concordancy between throat cultures, the sensitivity of the throat culture was only 87 percent. Despite the LA test's lower sensitivity (78 percent), in this clinical population with a relatively low prevalence of positive throat cultures (19 percent), the predictive value of a negative LA test was only slightly lower than that of the throat culture (94-95 percent vs. 97 percent). Backup throat cultures are commonly recommended for patients with initially negative LA test results, but 10 percent of the patients with group A beta-hemolytic streptococci-positive throat cultures would have been undetected using this approach.
Post-operative sore throat is a common minor complication after anesthesia. This paper reviews the factors which influence post-operative sore throat in intubated patients. Two hundred and sixty six intubated patients were investigated to find the incidence of sore throat after elective anesthesia in a middle eastern population. The overall incidence of sore throat was 63.9%. There was no significant difference in the incidence of sore throat between males and females, and in the age groups studied. Anesthetic factors including the use of relaxants, the experience of the anesthesiologist, the number of intubation attempts and lubrication of the tracheal tube did not significantly alter the incidence of sore throat. Duration of anesthesia of greater than 90 minutes was associated with significant increase in sore throat (p < 0.001). Surgical factors including type of surgery, the use of throat packs and early oral intake did not alter the incidence of sore throat. Nasogastric tube insertion was associated with a significantly increased incidence of sore throat (p < 0.01).
CONTEXT: Of children with sore throat, 15% to 36% have pharyngitis caused by group A beta-hemolytic streptococci (GABHS). Performance of a GABHS test prior to antibiotic prescribing is recommended for children with sore throat. Penicillin, amoxicillin, erythromycin, and first-generation cephalosporins are the recommended antibiotics for treatment of sore throat due to GABHS. OBJECTIVES: To measure rates of antibiotic prescribing and GABHS testing and to evaluate the association between testing and antibiotic treatment for children with sore throat. DESIGN, SETTING, AND PARTICIPANTS: Analysis of visits by children aged 3 to 17 years with sore throat to office-based physicians, hospital outpatient departments, and emergency departments in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1995 to 2003 (N = 4158) and of a subset of visits with GABHS testing data (n = 2797). MAIN OUTCOME MEASURES: National rates of antibiotic prescribing, prescribing of antibiotics recommended and not recommended for GABHS, and GABHS testing. RESULTS: Physicians prescribed antibiotics in 53% (95% confidence interval [CI], 49%-56%) of an estimated 7.3 million annual visits for sore throat and nonrecommended antibiotics to 27% (95% CI, 24%-31%) of children who received an antibiotic. Antibiotic prescribing decreased from 66% of visits in 1995 to 54% of visits in 2003 (P = .01 for trend). This decrease was attributable to a decrease in the prescribing of recommended antibiotics (49% to 38%; P = .002). Physicians performed a GABHS test in 53% (95% CI, 48%-57%) of visits and in 51% (95% CI, 45%-57%) of visits at which an antibiotic was prescribed. GABHS testing was not associated with a lower antibiotic prescribing rate overall (48% tested vs 51% not tested; P = .40), but testing was associated with a lower antibiotic prescribing rate for children with diagnosis codes for pharyngitis, tonsillitis, and streptococcal sore throat (57% tested vs 73% not tested; P<.001). CONCLUSIONS: Physicians prescribed antibiotics to 53% of children with sore throat, in excess of the maximum expected prevalence of GABHS. Although there was a decrease in the proportion of children receiving antibiotics between 1995 and 2003, this was due to decreased prescribing of agents recommended for GABHS. Although GABHS testing was associated with a lower rate of antibiotic prescribing for children with diagnosis codes of pharyngitis, tonsillitis, and streptococcal sore throat, GABHS testing was underused.