title: [ISKRA guidelines on sore throat: diagnostic and therapeutic approach--Croatian national guidelines].
abstract: Sore throat is most commonly caused by viruses, but when caused by bacteria, the most important is group A streptococcus (GAS). The aim of these guidelines is to determine optimal treatment for streptococcal sore throat and reasonable indications for tonsillectomy, as well as recommend how to differentiate streptococcal infection for which antibiotics are justified, from numerous other sore throats where antibiotics wont have a significant effect on disease course, but might contribute to bacterial resistance to antibiotics. The development of the guidelines was initiated by the Interdisciplinary Section for Antibiotic Resistance Control (ISKRA) of the Croatian Ministry of Health and Social Welfare in accordance with the principles of AGREE (Appraisal of Guidelines for Research and Evaluation) methodology which means that the guidelines are the result of consensus between all interested professional societies and institutions. For streptococcal sore throat diagnostics, the Working Group recommends evaluation of clinical presentation according to Centor criteria and for patients with Centor score 0-1, antibiotic therapy is not recommended nor bacteriological testing, while for patients with Centor score 2-4 bacteriological testing is recommended (rapid test or culture) as well as antibiotic therapy in case of positive result. The drug of choice for the treatment of streptococcal tonsillopharyngitis is oral penicillin taken for ten days (penicillin V) or in case of poor patient compliance benzathine penicillin G can be administered parenterally in a single dose. Other antibiotics (macrolides, clindamycin, cephalosporins, co-amoxiclav) are administered only in case of hypersensitivity to penicillin or in recurrent infections. Tonsillectomy is a widely accepted surgical procedure that decreases the number of sore throats in children and should be performed only if indications for this procedure are established. Absolute indications include five or more streptococcal infections per year, tonsillitis complications, permanent respiratory tract obstruction, obstructive sleep apnea syndrome and suspected tonsillar malignancy. Relative indications include chronic tonsillitis and occlusion disturbances.
authors.affiliation: Zavod za klinicku mikrobiologiju, Klinika za infektivne bolesti "Dr. Fran Mihaljević", Mirogojska 8, 10000 Zagreb. atambic@bfm.hr
authors.forename: Arjana Tambić
authors.initials: AT
authors.lastname: Andrasević
authors.forename: Tomislav
authors.initials: T
authors.lastname: Baudoin
authors.forename: Dalibor
authors.initials: D
authors.lastname: Vukelić
authors.forename: Suzana Mimica
authors.initials: SM
authors.lastname: Matanović
authors.forename: Danijela
authors.initials: D
authors.lastname: Bejuk
authors.forename: Diana
authors.initials: D
authors.lastname: Puzevski
authors.forename: Maja
authors.initials: M
authors.lastname: Abram
authors.forename: Goran
authors.initials: G
authors.lastname: Tesović
authors.forename: Zdravko
authors.initials: Z
authors.lastname: Grgurev
authors.forename: Gordana
authors.initials: G
authors.lastname: Tomac
authors.forename: Irina
authors.initials: I
authors.lastname: Pristas
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests; D010612:Pharyngitis / Q000175:diagnosis* / Q000188:drug therapy*; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000188:drug therapy*; D013297:Streptococcus pyogenes; D014068:Tonsillectomy; D014069:Tonsillitis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents