Streptococcal diagnostic testing and antibiotics prescribed for pediatric tonsillopharyngitis.
BACKGROUND
This study examined a 1-year cross-sectional sample of Kentucky Medicaid claims for the use of streptococcal diagnostic tests for pediatric tonsillopharyngitis and the empiric use of antibiotics.


METHODS
Subjects were individuals older than 3 and younger than 18 years old seen in an ambulatory setting for tonsillopharyngitis; 3478 individuals accounted for the 5067 separate outpatient and emergency room encounters for pediatric tonsillopharyngitis; 849 encounters coded as streptococcal sore throat were also examined.


RESULTS
Diagnostic tests for group A streptococcal tonsillopharyngitis were performed in only 22% (n = 1130) of the tonsillopharyngitis encounters and 36% (n = 306) of the streptococcal sore throat encounters. Urban physicians were more likely than rural physicians to use a diagnostic test (P = 0.0001). Emergency room encounters and outpatient encounters were not significantly different in the likelihood of having a diagnostic test (P = 0.16). In encounters for tonsillopharyngitis antibiotics were prescribed in 72% of the total encounters and in 73% of the encounters without a diagnostic streptococcal test. In encounters for streptococcal sore throat, antibiotics were prescribed for 68% of the total encounters and 69% of the encounters without a diagnostic streptococcal test.


CONCLUSIONS
Current practices in the Kentucky Medicaid program do not follow the American Academy of Pediatrics guidelines for streptococcal tonsillopharyngitis.
Mainous
A G
AG
Department of Family Practice, University of Kentucky, Lexington, USA.
Zoorob
R J
RJ
Kohrs
F P
FP
Hagen
M D
MD
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid; D010612:Pharyngitis / Q000175:diagnosis / Q000188:drug therapy*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy*; D013297:Streptococcus pyogenes; D014069:Tonsillitis / Q000175:diagnosis / Q000188:drug therapy*; D014481:United States
D000900:Anti-Bacterial Agents