A clinical decision rule for management of streptococcal pharyngitis in low-resource settings.
BACKGROUND
Most of the world's children live in regions where laboratory facilities are not available. In these regions, clinical prediction rules can be useful to guide clinicians' decisions on antibiotic therapy for streptococcal pharyngitis, and to reduce routine presumptive antibiotic therapy for all pharyngitis.


METHODS
Prospective cohort study to assess diagnostic signs and develop a prediction rule. Bivariate and multivariate analyses were used to develop clinical rules. Participants were 410 children in Cairo, Egypt, aged from 2 to 12 y, presenting with complaint of sore throat and whose parents provided consent. Main outcome measures included presence of signs and symptoms, and positive group A beta hemolytic streptococcal (GABHS) culture.


RESULTS
101 (24.6%) children had positive GABHS culture. Pharyngeal exudate, tender or enlarged anterior cervical lymph nodes, season, absence of rash, or cough or rhinitis were associated with positive culture in bivariate and multivariate analyses. Three variables (enlarged nodes, no rash, no rhinitis), when used in a cumulative score, showed 92% sensitivity and 38% specificity in these children.


CONCLUSIONS
The proposed three-variable clinical prediction rule for GABHS may be useful when diagnostic laboratories are not available. In this setting, the rule identified more than 90% of true cases. Compared to universal treatment of all pharyngitis, the rule will reduce antibiotic use in GABHS-negative cases by about 40%.
Steinhoff
Mark C
MC
Department of International Health, Bloomberg School of Public Health, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA. msteinho@jhsph.edu
Walker
Christa Fischer
CF
Rimoin
Anne W
AW
Hamza
Hala S
HS
D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine / Q000191:economics* / Q000379:methods; D004534:Egypt; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010406:Penicillins / Q000191:economics / Q000627:therapeutic use; D010612:Pharyngitis / Q000175:diagnosis* / Q000188:drug therapy; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics*; D013297:Streptococcus pyogenes / Q000187:drug effects / Q000302:isolation & purification*; D016896:Treatment Outcome; D014505:Urban Population
D010406:Penicillins