Validation of Different Clinical Prediction Scores to Guide Management of Children with Acute Sore Throat in Primary Care Practice

Abstract

S treptococcus pyogenes (GAS) is a major cause of morbidity and mortality worldwide. GAS accounts for 20% to 40% of sore throat cases in children and 5% to 15% in adults. In primary care, roughly, third of the patients with respiratory tract infections presents with sore throat and almost third of the antibiotics are prescribed for these infections. Although GAS pharyngitis is a superficial infection in the throat, it can lead to various types of suppurative and non- suppurative complication. The suppurative sequelae include peritonsillar cellulitis abscess (quinsy), retropharyngeal, cervical lymphadenitis, sinusitis, acute otitis media and mastoiditis. On the other hand, the non-suppurative post-streptococcal diseases occur as an autoimmune inflammatory response to GAS infection affecting mainly heart and kidney causing acute rheumatic fever (ARF) and acute glomerulonephritis. Antibiotic treatment of acute streptococcal sore throat can prevent acute rheumatic fever, however, presumptive antibiotic prescriptions to patients with streptococcal pharyngitis without relying on a valid clinical guidance or a diagnostic test can predispose to upsurge in the carrier state and in the rate of antibiotic-resistant strains of GAS.