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. 2023 Mar 31;13(1):32-39.
doi: 10.18683/germs.2023.1364. eCollection 2023 Mar.

Assessment of adherence to guidelines for testing and treatment of pharyngitis among children in Palestine: A retrospective review study

Shahenaz Najjar  1 , Haya O Sultan  2 , Hiba H Falana  2 , Razan O Ata  3 , Maryam A Manasrah  3 , Mutaz Dreidi  4 , Abdallah D Abukhalil  5 , Hani Naseef  6
Affiliations

Assessment of adherence to guidelines for testing and treatment of pharyngitis among children in Palestine: A retrospective review study

Shahenaz Najjar et al. Germs. .

Abstract

Introduction: One of the most common reasons for pediatric outpatient visits is acute pharyngitis, an upper respiratory tract infection. Bacterial pharyngitis is caused by Group A beta-hemolytic Streptococcus (GABHS), also known as Streptococcus pyogenes. This research aimed to assess physicians' adherence to clinical guidelines for diagnosis, management, and selecting appropriate treatment for children suspected of bacterial pharyngitis.

Methods: A retrospective, observational study was conducted by reviewing patient charts for childred aged 3 to 13 years old diagnosed with pharyngitis from June 2019 until December 2019 at the Emergency Department of Palestine Medical Complex (PMC). The Modified Centor score, throat swab collections, and assessment of antimicrobial selection were used to assess the extent of physicians' adherence to clinical guidelines for appropriate diagnosis and management of pharyngitis. SPSS was used for data analysis.

Results: Out of 290 cases diagnosed with acute pharyngitis, 217 patients (74.8%) had a Modified Centor score of ≥2; 126 received antibiotics, and eight had their throat swabbed to confirm the diagnosis; furthermore, 73 patients (25.2%) had a Modified Centor score of <2; 34 of them received antibiotics. Azithromycin was the most commonly prescribed antibiotic (41.3%), followed by amoxicillin-clavulanic acid (38.1%). The frequency of empirical antibiotics prescribing was significantly higher among children with a Centor score >2, older children, and those presenting with fever.

Conclusions: Most cases were not appropriately tested to confirm the diagnosis of bacterial pharyngitis and were mostly treated with inappropriate antimicrobial agents such as azithromycin. Nonadherence to clinical guidelines is very evident in this study.

Keywords: Pharyngitis; antibiotic; bacterial resistance; overuse; swab culture.

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Conflict of interest statement

Conflicts of interest: All authors – none to declare.

Figures

Figure 1.
Figure 1.. Antibiotics prescribed over the selected months
See this image and copyright information in PMC

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