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.

Sore 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.