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. 2023 Sep 5;49(1):114.
doi: 10.1186/s13052-023-01514-8.

Nationwide survey on the management of pediatric pharyngitis in Italian emergency units

Gregorio P Milani #  1   2 , Claudio Rosa #  3 , Naz Tuzger #  4   3 , Ilaria Alberti  4 , Chiara Ghizzi  5 , Stefania Zampogna  6 , Angela Amigoni  7 , Carlo Agostoni  4   3 , Diego Peroni  8 , Paola Marchisio  4   9 , Elena Chiappini  10 ; IPSE study group
Collaborators, Affiliations

Nationwide survey on the management of pediatric pharyngitis in Italian emergency units

Gregorio P Milani et al. Ital J Pediatr. .

Abstract

Background: Acute pharyngitis is a frequent reason for primary care or emergency unit visits in children. Most available data on pharyngitis management come from primary care studies that demonstrate an underuse of microbiological tests, a tendency to over-prescribe antibiotics and a risk of antimicrobial resistance increase. However, a comprehensive understanding of acute pharyngitis management in emergency units is lacking. This study aimed to investigate the frequency of rapid antigen test use to diagnose acute pharyngitis, as well as other diagnostic approaches, the therapeutic attitude, and follow-up of children with this condition in the emergency units.

Methods: A multicentric national study was conducted in Italian emergency departments between April and June 2022.

Results: A total of 107 out of 131 invited units (response rate 82%), participated in the survey. The results showed that half of the units use a scoring system to diagnose pharyngitis, with the McIsaac score being the most commonly used. Most emergency units (56%) were not provided with a rapid antigen diagnostic test by their hospital, but the test was more frequently available in units visiting more than 10,000 children yearly (57% vs 33%, respectively, p = 0.02). Almost half (47%) of the units prescribe antibiotics in children with pharyngitis despite the lack of microbiologically confirmed cases of Group A β-hemolytic streptococcus. Finally, about 25% of units prescribe amoxicillin-clavulanic acid to treat Group A β-hemolytic streptococcus pharyngitis.

Conclusions: The study sheds light on the approach to pharyngitis in emergency units, providing valuable information to improve the appropriate management of acute pharyngitis in this setting. The routinary provision of rapid antigen tests in the hospitals could enhance the diagnostic and therapeutic approach to pharyngitis.

Keywords: Antibiotic stewardship; Group A β-hemolytic streptococcus. Management; Over prescription; Test.

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Conflict of interest statement

The authors declare that they have no competing interests related to this article.

Figures

Fig. 1
Fig. 1
(left panel): Frequency of the use of clinical scoring systems in the Italian emergency units; (right panel): Type of clinical score systems utilized in the Italian emergency units
Fig. 2
Fig. 2
Use of microbiological follow-up in children with Group A β-hemolytic streptococcus
See this image and copyright information in PMC

References

    1. Dooling KL, Shapiro DJ, Van Beneden C, Hersh AL, Hicks LA. Overprescribing and inappropriate antibiotic selection for children with pharyngitis in the United States, 1997–2010. JAMA Pediatr. 2014;168(11):1073–1074. doi: 10.1001/jamapediatrics.2014.1582. - DOI - PubMed
    1. Gerber MA. Diagnosis and treatment of pharyngitis in children. Pediatr Clin North Am. 2005;52(3):729–747. doi: 10.1016/j.pcl.2005.02.004. - DOI - PMC - PubMed
    1. Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics. 2010;126(3):e557–564. doi: 10.1542/peds.2009-2648. - DOI - PubMed
    1. Chiappini E, Principi N, Mansi N, Serra A, De Masi S, Camaioni A, Esposito S, Felisati G, Galli L, Landi M, et al. Management of acute pharyngitis in children: summary of the Italian National Institute of Health guidelines. Clin Ther. 2012;34(6):1442–1458.e1442. doi: 10.1016/j.clinthera.2012.04.028. - DOI - PubMed
    1. Mustafa Z, Ghaffari M. Diagnostic Methods, Clinical Guidelines, and Antibiotic Treatment for Group A Streptococcal Pharyngitis: A Narrative Review. Front Cell Infect Microbiol. 2020;10:563627. doi: 10.3389/fcimb.2020.563627. - DOI - PMC - PubMed

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