Evaluation of culture and antibiotic use in patients with pharyngitis.
OBJECTIVE
The objectives of this study were to evaluate practice patterns for treatment of patients with pharyngitis with regard to testing for group A beta hemolytic streptococcal (GABHS) infection, frequency of antibiotic use, and appropriate choice of antibiotics.


METHODS
The authors conducted a retrospective review of billing data for 10,482 office visits for pharyngitis.


METHODS
The 2004 billing database for a tertiary institution was queried for outpatient visits for pharyngitis or tonsillitis, group A Streptococcus tests (GAST), and antibiotic prescriptions filled after the visit. Patients were separated by age group and analyzed for the proportion of patients that received a GAST and proportion prescribed an antibiotic. Antibiotic prescriptions were also analyzed to determine whether they were appropriate for treatment of GABHS.


RESULTS
A total of 68.7% of all patients and 82.2% of pediatric patients were tested for GAST. A total of 47.1% of adult patients and 44.9% of pediatric patients received an antibiotic. For adult patients for whom GAST was obtained, 48.6% were prescribed an antibiotic versus 53.6% of those not tested. Streptococcus testing was a significant predictor of antibiotic use (P < .0001), whereas age was not (P = .22). A total of 82.1% of all antibiotics prescribed were recommended for treatment of GABHS.


CONCLUSIONS
Most patients seen for pharyngitis were tested for GABHS, but pediatric patients were tested more frequently than adults. Patients who received a GAST were less likely to receive antibiotics. The rates experienced in our tertiary academic institution are higher than previously quoted for community practice. When antibiotics were prescribed, they were usually appropriate for the treatment of GABHS based on current recommendations.
Rufener
Justin B
JB
Department of Otolaryngology, Head & Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA. 313jrufene1@hfhs.org
Yaremchuk
Kathleen L
KL
Payne
Spencer C
SC
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001431:Bacteriological Techniques; D002648:Child; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D017723:Drug Utilization Review; D006801:Humans; D010612:Pharyngitis / Q000188:drug therapy / Q000382:microbiology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D014069:Tonsillitis / Q000188:drug therapy / Q000382:microbiology
D000900:Anti-Bacterial Agents