title: Pharyngitis in low-resources settings: a pragmatic clinical approach to reduce unnecessary antibiotic use.
abstract: OBJECTIVE
  Existing scoring systems for the diagnosis of group A streptococcus pharyngitis are insensitive or inapplicable in low-resources settings. Bacterial cultures and rapid tests can allow for antibiotic prescription abstention in high-income regions. These techniques are not feasible in many low-resources settings, and antibiotics often are prescribed for any pharyngitis episode. However, judicious antibiotics prescription in the community also is of concern in low-income countries. The objective of this study was to develop a clinical decision rule that allows for the reduction of empirical antibiotic therapy for children with pharyngitis in low-resources settings by identifying non-group A streptococcus pharyngitis.
  
  
  METHODS
  We prospectively included children with pharyngitis in 3 public hospitals of Brazil during 9 months in 2004. We filled out clinical questionnaires and performed throat swabs. Bilateral chi2 (2-tailed test) and multivariate analysis were used to determine score categories. The outcome measures were sensitivity, specificity, positive likelihood ratio, and posttest probability of non-group A streptococcus infection with the clinical approach as compared with throat culture.
  
  
  RESULTS
  A total of 163 of the 220 children had non-group A streptococcus pharyngitis (negative culture). We established a 3-questions decision rule (age and viral and bacterial signs) with 3 possible answers. The use of this score would prevent 41% to 55% of unnecessary antimicrobial prescriptions. The specificity of the score for non-group A streptococcus pharyngitis was >84%.
  
  
  CONCLUSIONS
  Such a clinical decision rule could be helpful to reduce significantly unnecessary antibiotic prescriptions for pharyngitis in children in low-resources settings.
authors.affiliation: Serviço de Pediatria, Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil. psmeeste@ulb.ac.be
authors.forename: Pierre Robert
authors.initials: PR
authors.lastname: Smeesters
authors.forename: Dioclécio
authors.initials: D
authors.lastname: Campos
authors.forename: Laurence
authors.initials: L
authors.lastname: Van Melderen
authors.forename: Eurico
authors.initials: E
authors.lastname: de Aguiar
authors.forename: Jean
authors.initials: J
authors.lastname: Vanderpas
authors.forename: Anne
authors.initials: A
authors.lastname: Vergison
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000592:standards; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010612:Pharyngitis / Q000188:drug therapy* / Q000382:microbiology*; D011203:Poverty; D011446:Prospective Studies; D013290:Streptococcal Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents