Park Sarah Y, Gerber Michael A, Tanz Robert R, Hickner John M, Galliher James M, Chuang Ilin, Besser Richard E
Epidemiology Program Office, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Atlanta, Georgia, USA.
Pediatrics. 2006 Jun;117(6):1871-8. doi: 10.1542/peds.2005-2323.
Sore throat is a common complaint in children and adolescents. With increasing antimicrobial resistance because of antimicrobial overuse, accurate diagnosis is imperative. Appropriate management of acute pharyngitis depends on proper use and interpretation of clinical findings, rapid antigen-detection tests, and throat cultures. We surveyed pediatricians and family physicians to evaluate their management strategies for children and adolescents with acute pharyngitis and to assess the availability and use of diagnostic tests in office practice.
In 2004, surveys were mailed to a random sample of 1000 pediatrician members of the American Academy of Pediatrics and 1000 family physician members of the American Academy of Family Physicians. We assessed factors associated with physicians using an appropriate management strategy for treating acute pharyngitis.
Of 948 eligible responses, 42% of physicians would start antimicrobials before knowing diagnostic test results and continue them despite negative results, with 27% doing this often or always. When presented with clinical scenarios of patients with acute pharyngitis, < or =23% chose an empirical approach, 32% used an inappropriate strategy for a child with pharyngitis suggestive of group A Streptococcus, and 81% used an inappropriate strategy for a child with findings consistent with viral pharyngitis. Plating cultures in the office was associated with an appropriate management strategy, although not statistically significant. Solo/2-person practice and rural location were both independent factors predicting inappropriate strategies.
There is much room for improvement in the management of acute pharyngitis in children and adolescents. Most physicians use appropriate management strategies; however, a substantial number uses inappropriate ones, particularly for children with likely viral pharyngitis. Efforts to help physicians improve practices will need to be multifaceted and should include health policy and educational approaches.
喉咙痛是儿童和青少年常见的主诉。由于抗菌药物的过度使用导致抗菌药物耐药性增加，准确诊断至关重要。急性咽炎的恰当管理取决于对临床发现、快速抗原检测试验和咽拭子培养的正确使用和解读。我们对儿科医生和家庭医生进行了调查，以评估他们对患有急性咽炎的儿童和青少年的管理策略，并评估在门诊实践中诊断测试的可用性和使用情况。
2004年，我们将调查问卷邮寄给美国儿科学会1000名儿科医生成员和美国家庭医生学会1000名家庭医生成员的随机样本。我们评估了与医生使用恰当管理策略治疗急性咽炎相关的因素。
在948份合格回复中，42%的医生在知晓诊断测试结果之前就会开始使用抗菌药物，并且即便结果为阴性仍会继续使用，其中27%的医生经常或总是这样做。当面对急性咽炎患者的临床情况时，≤23%的医生选择经验性方法，32%的医生对疑似A组链球菌性咽炎的儿童使用了不恰当的策略，81%的医生对具有符合病毒性咽炎表现的儿童使用了不恰当的策略。在办公室进行培养皿接种与恰当的管理策略相关，尽管无统计学意义。单人/两人执业以及地处农村均是预测不恰当策略的独立因素。
儿童和青少年急性咽炎的管理有很大的改进空间。大多数医生使用恰当的管理策略；然而，相当一部分医生使用不恰当的策略，特别是对于可能患有病毒性咽炎的儿童。帮助医生改进实践的努力需要多方面进行，应包括卫生政策和教育方法。
