title: Pharyngitis management: defining the controversy.
abstract: Despite numerous controlled trials, clinical practice guidelines and cost-effective analyses, controversy persists regarding the appropriate management strategy for adult pharyngitis. In this perspective, we explore this controversy by comparing two competing clinical guidelines. Although the guidelines appear to make widely diverging recommendations, we show that the controversy centers on only a small proportion of patients: those presenting with severe pharyngitis. We examine recently published data to illustrate that this seemingly simple problem of strep throat remains a philosophical issue: should we give primacy to relieving acute time-limited symptoms, or should we emphasize the potential societal risk of antibiotic resistance? We accept potentially over treating a minority of adult pharyngitis patients with the most severe presentations to reduce suffering in an approximately equal number of patients who will have false negative test results if the test-and-treat strategy were used.
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL 35294-3407, USA. rcentor@uab.edu
authors.forename: Robert Maccabee
authors.initials: RM
authors.lastname: Centor
authors.forename: Jeroan Julius
authors.initials: JJ
authors.lastname: Allison
authors.forename: Stuart James
authors.initials: SJ
authors.lastname: Cohen
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000942:Antigens, Bacterial / Q000032:analysis; D024881:Drug Resistance, Bacterial; D006801:Humans; D010612:Pharyngitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D011933:Reagent Kits, Diagnostic; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial; D011933:Reagent Kits, Diagnostic