RECONSIDERING SORE THROATS .2. ALTERNATIVE APPROACH AND PRACTICAL OFFICE TOOL

OBJECTIVE To identify a management approach for Group A streptococcal (GAS) pharyngitis that would address overuse of antibiotics and could be implemented immediately. QUALITY OF EVIDENCE No randomized, control led trials were found; four observational studies met our criteria: si mplicity, discrimination ability for GAS pharyngitis compared with thr oat culture, and validation in a different patient population. Only on e scoring system fulfilled all three criteria. MAIN FINDINGS Formal cl inical scoring systems have the potential to improve family physicians ' ability to identify and manage GAS pharyngitis. One system had been sufficiently validated to support its use in clinical practice. Four c linical characteristics (no cough, fever higher than 38 degrees C, exu date, and tender cervical nodes) linked to explicit management decisio ns form the basis for a sore throat score. CONCLUSIONS Use of a clinic al score for management of GAS pharyngitis can be recommended on the b asis of the rarity of rheumatic fever in modern society, the resources devoted to management of upper respiratory tract illnesses, the volum e of antibiotics prescribed, and the emergence of antibiotic resistanc e as a growing health issue.