Acute pharyngitis: low adherence to guidelines highlights need for greater flexibility in managing paediatric cases
Article first published online: 10 AUG 2013
©2013 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd
Volume 102, Issue 11, pages 1075–1080, November 2013
How to Cite
Urkin, J., Allenbogen, M., Friger, M., Vinker, S., Reuveni, H. and Elahayani, A. (2013), Acute pharyngitis: low adherence to guidelines highlights need for greater flexibility in managing paediatric cases. Acta Paediatrica, 102: 1075–1080. doi: 10.1111/apa.12364
- Issue published online: 3 OCT 2013
- Article first published online: 10 AUG 2013
- Accepted manuscript online: 23 JUL 2013 06:57AM EST
- Manuscript Accepted: 18 JUL 2013
- Manuscript Revised: 7 MAY 2013
- Manuscript Received: 28 FEB 2013
- Overuse of antibiotics;
- Primary physician;
- Sore throat
To describe how physicians manage acute pharyngitis with respect to the clinical guidelines.
The computerized medical records of 105 961 children in one district of a large health maintenance organization were analysed, to identify children aged 0–18 years with a diagnosis of pharyngitis and paying their first visit for pharyngitis. Main outcome variables were whether a throat culture was performed and the time between their medical consultation and purchasing any antibiotics, if at all.
A total of 28 511 episodes of pharyngitis in 19 865 children aged 0–18, recorded by 125 physicians, were analysed (average of 1.4 episodes per child). Throat cultures were performed in 14 847 episodes (52%), with tests more common among paediatricians and younger physicians. Antibiotics were purchased in 24.8% of these cases, without knowing the result, and were more commonly associated with male physicians, family practitioners, children living in rural areas and drugs bought before the weekend.
About 50% of the physicians did not adhere to the guidelines. Factors influencing adherence included physician training, years in practice and patients' nonmedical characteristics. It is suggested that the existing clinical guidelines should address additional modifiers that will make the more applicable in practice.