NR 511 Week 7 CPG assignment
Differential Diagnosis & Primary
Care Practicum A+
, Group A Streptococcus is the most common bacterial cause of acute pharyngitis. Acute
pharyngitis is one of the most frequent illnesses for which pediatricians and other primary care
physicians are consulted, with an estimated 15 million visits per year in the United States.
Patients will often present with a sore, scratchy throat, fever, headache, nausea,
vomiting, abdominal pain, patchy tonsillopharyngeal exudates and some anterior cervical
adenitis. The infection is generally transmitted by direct contact with the mucus or sores of
someone else that has strep throat. Strep throat is spread through airborne respiratory droplets
such as by coughing or sneezing and by saliva when you kiss someone or drink after someone
that has the infection.
The organization that developed this Clinical practice guideline is the Infectious Disease Society
of America in 2015. This CPG is applicable in the primary care setting as it explains the tests to
help diagnose and treat streptococcal pharyngitis. Accurate diagnosis of group A streptococcal
pharyngitis by clinical symptoms alone is limited due to the overlap of clinical signs and
symptoms between bacterial and viral pharyngitis. Current guidelines recommend using a rapid
antigen detection test (RADT) and/or bacterial culture of throat swab. A negative RADT result
requires a confirmatory bacterial culture in pediatric patients, and patients at high risk of
complications for GAS pharyngitis. The bacterial culture is both highly sensitive and specific
when performed correctly (90-95%). Clinicians are often left with the difficult decision of
whether or not to prescribe antibiotics when using the rapid antigen assays while waiting for the
confirmed results or to go ahead and treat the patient and accept any negative clinical
consequences or follow-up care. This CPG is one that would be well used in the
primary care setting as strep pharyngitis is a very common diagnosis in adults and children.
This specific study evaluated the overall diagnosis and treatment of acute pharyngitis in the
United States, including predictors of test type and antibiotic prescription. Most cases of
pharyngitis will resolve on their own without treatment, however, antibiotics are prescribed in
approximately 60% of cases to prevent rare complications (acute rheumatic fever, rheumatic
heart disease, post-streptococcal glomerulonephritis), shorten the duration of illness, prevent the
spread of infection to close contacts, and address patient demands. Current treatment guidelines
discourage the empirical use of antibiotics for sore throats due to concerns about unnecessary
antibiotic exposure and development of resistance. Patients who have a positive RADT or throat
culture require antibiotics (strong, high). Clinicians should not treat viral pharyngitis with
antibiotics.
The recommendation for treatment of acute GAS pharyngitis is:
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