Effect of a standardized pharyngitis treatment protocol on use of antibiotics in a pediatric emergency department.
BACKGROUND
Pharyngitis is a common complaint in pediatric patients. If clinical parameters are used alone, bacterial pathogens will be wrongly implicated in many cases. A nonstandardized approach to the treatment of children with pharyngitis in an emergency department setting may lead to inappropriate empirical therapy, contribute to increased bacterial resistance, and result in adverse events related to the treatment provided.


OBJECTIVE
To implement evidence-based guidelines for the diagnosis and treatment of children with pharyngitis in an emergency department setting and thereby influence practices of prescribing antibiotics.


METHODS
An evidence-based guideline for the evaluation and treatment of patients with pharyngitis was developed and implemented in our emergency department. Preintervention and postintervention patient cohorts were identified by a search of the emergency department's clinical repository. A medical record review was performed using a standardized data abstraction form (history and examination data, diagnostic testing, and therapy provided). Treatment decisions were judged as appropriate if the diagnosis of pharyngitis caused by group A beta-hemolytic streptococci was based on confirmatory microbiological testing rather than on the history and physical examination findings alone.


RESULTS
We included 443 patients for study (219 preintervention and 224 postintervention). In the preintervention group, 97 (44%) of 214 received appropriate treatment. In the postintervention group, 204 (91%) of 224 received appropriate treatment.


CONCLUSIONS
An evidence-based clinical guideline can influence and improve practices of prescribing antibiotics by pediatric emergency physicians in a teaching hospital setting.
Department of Pediatrics, Northeastern Ohio Universities College of Medicine, and Pediatric Emergency Services, Children's Hospital Medical Center of Akron, Akron, Ohio, USA. mcdiaz@NEMOURS.org
Maria Carmen G
MC
Diaz
Nadine
N
Symons
Maria L
ML
Ramundo
Norman C
NC
Christopher
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D010612:Pharyngitis / Q000188:drug therapy* / Q000382:microbiology*; D017410:Practice Guidelines as Topic; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents