Sore Throat: Avoid Overcomplicating the Uncomplicated
Authors: Jeffrey A. Linder
Journal: Annals of Internal Medicine (2015)

Editorials17 February 2015Sore Throat: Avoid Overcomplicating the UncomplicatedJeffrey A. Linder, MD, MPHJeffrey A. Linder, MD, MPHFrom Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-2899 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Management of most patients with a sore throat is not complicated. Respiratory viruses cause most sore throat cases. In the United States, sore throat and pharyngitis guidelines focus on separating patients with respiratory viruses from patients likely to have group A streptococcus (1). Antibiotic treatment of group A streptococcus decreases symptoms, prevents suppurative complications, and decreases contagion.Patients with a Centor score of 0 or 1 (1 point each for history of fever, absence of cough, tender anterior cervical lymphadenopathy, and tonsillar exudates) are unlikely to have group A streptococcus; therefore, further testing is not useful. For patients with a ...References1. Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55:1279-82. [PMID: 23091044] doi:10.1093/cid/cis847 CrossrefMedlineGoogle Scholar2. Fine AM, Nizet V, Mandl KD. Large-scale validation of the Centor and McIsaac scores to predict group A streptococcal pharyngitis. Arch Intern Med. 2012;172:847-52. [PMID: 22566485] doi:10.1001/archinternmed.2012.950 CrossrefMedlineGoogle Scholar3. Linder JA, Chan JC, Bates DW. Evaluation and treatment of pharyngitis in primary care practice: the difference between guidelines is largely academic. Arch Intern Med. 2006;166:1374-9. [PMID: 16832002] CrossrefMedlineGoogle Scholar4. Fine AM, Nizet V, Mandl KD. Participatory medicine: A home score for streptococcal pharyngitis enabled by real-time biosurveillance: a cohort study. Ann Intern Med. 2013;159:577-83. [PMID: 24189592] doi:10.7326/0003-4819-159-9-201311050-00003 LinkGoogle Scholar5. Barnett ML, Linder JA. Antibiotic prescribing to adults with sore throat in the United States, 1997-2010. JAMA Intern Med. 2014;174:138-40. [PMID: 24091806] doi:10.1001/jamainternmed.2013.11673 CrossrefMedlineGoogle Scholar6. Kuppalli K, Livorsi D, Talati NJ, Osborn M. Lemierre's syndrome due to Fusobacterium necrophorum. Lancet Infect Dis. 2012;12:808-15. [PMID: 22633566] doi:10.1016/S1473-3099(12)70089-0 CrossrefMedlineGoogle Scholar7. Centor RM. Expand the pharyngitis paradigm for adolescents and young adults. Ann Intern Med. 2009;151:812-5. [PMID: 19949147] doi:10.7326/0003-4819-151-11-200912010-00011 LinkGoogle Scholar8. Centor RM, Atkinson TP, Ratliff AE, Xiao L, Crabb DM, Estrada CA, et al. The clinical presentation of Fusobacterium–positive pharyngitis and streptococcal–positive pharyngitis in a university health clinic. A cross-sectional study. Ann Intern Med. 2015;162:241-7. doi:10.7326/M14-1305 LinkGoogle Scholar9. Gunnarsson RK, Holm SE, Söderström M. The prevalence of beta-haemolytic streptococci in throat specimens from healthy children and adults. Implications for the clinical value of throat cultures. Scand J Prim Health Care. 1997;15:149-55. [PMID: 9323783] CrossrefMedlineGoogle Scholar10. Garrett WS, Onderdonk AB. Bacteroides, Prevotella, Porphyromonas, and Fusobacterium species (and other medically important anaerobic gram-negative bacilli).. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia: Elsevier Saunders; 2015:2773-80. Google Scholar Author, Article, and Disclosure InformationAuthors: Jeffrey A. Linder, MD, MPHAffiliations: From Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.Grant Support: Dr. Linder has been supported by grants from the National Institutes of Health (RC4 AG039115), the National Institute of Allergy and Infectious Diseases (R21 AI097759), and the Agency for Healthcare Research and Quality (R18 HS018419).Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2899.Corresponding Author: Jeffrey A. Linder, MD, MPH, Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, BC-3-2X, Boston, MA 02120; e-mail, [email protected]org. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Clinical Presentation of Fusobacterium-Positive and Streptococcal-Positive Pharyngitis in a University Health Clinic Robert M. Centor , T. Prescott Atkinson , Amy E. Ratliff , Li Xiao , Donna M. Crabb , Carlos A. Estrada , Michael B. Faircloth , Lisa Oestreich , Jeremy Hatchett , Walid Khalife , and Ken B. Waites The Clinical Presentation of Fusobacterium-Positive and Streptococcal-Positive Pharyngitis in a University Health Clinic Robert M. Centor , T. Prescott Atkinson , Amy E. Ratliff , Li Xiao , Donna M. Crabb , Carlos A. Estrada , Michael B. Faircloth , Lisa Oestreich , Jeremy Hatchett , Walid Khalife , and Ken B. Waites Sore Throat: Avoid Overcomplicating the Uncomplicated Robert M. Centor , T. Prescott Atkinson , Carlos Estrada , and Ken B. Waites Sore Throat: Avoid Overcomplicating the Uncomplicated Jeffrey A. Linder Sore Throat: Avoid Overcomplicating the Uncomplicated Robert M. Centor , T. Prescott Atkinson , Carlos Estrada , and Ken B. Waites Sore Throat: Avoid Overcomplicating the Uncomplicated Jeffrey A. Linder Annals On Call - Fusobacterium Pharyngitis Debate Robert M. Centor and Jeffrey A. Linder Metrics Cited byAge and sex-specific incidence rates of group A streptococcal pharyngitis between 2010 and 2018: a population-based studyPatología infecciosa aguda de foco otorrinolaringológicoThe Slow-Motion Catastrophe of Antimicrobial Resistance and Practical Interventions for All PrescribersThe long shadow of Lemierre's syndromePoint-Counterpoint: A Nucleic Acid Amplification Test for Streptococcus pyogenes Should Replace Antigen Detection and Culture for Detection of Bacterial PharyngitisFusobacterium-Positive and Streptococcal-Positive PharyngitisJan Matthys, MD, Marc De Meyere, MD, and An De Sutter, MDSore Throat: Avoid Overcomplicating the UncomplicatedRobert M. Centor, MD, T. Prescott Atkinson, MD, Carlos Estrada, MD, and Ken B. Waites, MD 17 February 2015Volume 162, Issue 4Page: 311-312KeywordsAdolescentsAntibioticsFusobacterium necrophorumInfectious diseasesPatientsPenicillinPharyngitisPolymerase chain reactionStreptococcusYoung adults ePublished: 17 February 2015 Issue Published: 17 February 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...