Cincinnati—Antibiotic therapy guided by the traditional throat
culture is the most effective and least costly strategy for the
management of sore throats in children, according to results of a
University of Cincinnati (UC) research study published in the July 2
issue of Archives of Pediatrics and Adolescent Medicine.
According to UC and Children's Hospital Medical Center investigators
Joel Tsevat, MD, MPH, of the Section of Outcomes Research of the
Division of General Internal Medicine and the Institute for Health
Policy and Health Services Research, and Uma Kotagal, MD, MSc,
Divisions of Neonatology and Health Policy and Clinical Effectiveness,
Department of Pediatrics, and Institute for Health Policy and Health
Services Research, pharyngitis is a major health and economic issue,
yet there is no agreement on how to manage children with sore throats.
throats are one of the most common complaints of patients during office
visits with their doctors and accounted for nearly 18 million office
visits in 1996. Strep throat is the most serious cause of sore throats
and it can cause complications like rheumatic fever. But strep throat
accounts for only 15-30 percent of cases of sore throats, says Kotagal.
Penicillin is the drug of choice for strep throat, but it is not used
to treat other causes of sore throat. In addition, penicillin allergy
is fairly common.
The study by Tsevat and Kotagal compared the
costs and health outcomes from seven possible strategies for evaluating
and treating children with sore throats, including neither testing nor
treating, testing for strep using two kinds of rapid strep tests with
or without throat cultures, basing treatment on throat cultures alone,
and treating with penicillin without testing for strep. Rapid strep
tests give results a day or two faster than throat cultures, but are
often less accurate.
Results of their study show that obtaining a
throat culture and treating patients whose culture is positive with
penicillin is the least costly and most effective strategy. In certain
cases, an optical immunoassay rapid strep test can be more effective,
but it is more costly. In an analysis taking the parent's perspective,
doing nothing and treating without testing are the least expensive
strategies, but neither strategy is likely to be acceptable. The
authors concluded, therefore, that children with sore throats should
generally get throat cultures in lieu of rapid strep tests.