title: Acute pharyngitis: low adherence to guidelines highlights need for greater flexibility in managing paediatric cases.
abstract: OBJECTIVE
  To describe how physicians manage acute pharyngitis with respect to the clinical guidelines.
  
  
  METHODS
  The computerized medical records of 105 961 children in one district of a large health maintenance organization were analysed, to identify children aged 0-18 years with a diagnosis of pharyngitis and paying their first visit for pharyngitis. Main outcome variables were whether a throat culture was performed and the time between their medical consultation and purchasing any antibiotics, if at all.
  
  
  RESULTS
  A total of 28 511 episodes of pharyngitis in 19 865 children aged 0-18, recorded by 125 physicians, were analysed (average of 1.4 episodes per child). Throat cultures were performed in 14 847 episodes (52%), with tests more common among paediatricians and younger physicians. Antibiotics were purchased in 24.8% of these cases, without knowing the result, and were more commonly associated with male physicians, family practitioners, children living in rural areas and drugs bought before the weekend.
  
  
  CONCLUSIONS
  About 50% of the physicians did not adhere to the guidelines. Factors influencing adherence included physician training, years in practice and patients' nonmedical characteristics. It is suggested that the existing clinical guidelines should address additional modifiers that will make the more applicable in practice.
authors.affiliation: Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Division of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel; Clalit Health Services, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Urkin
authors.forename: Meirave
authors.initials: M
authors.lastname: Allenbogen
authors.forename: Michael
authors.initials: M
authors.lastname: Friger
authors.forename: Shlomo
authors.initials: S
authors.lastname: Vinker
authors.forename: Haim
authors.initials: H
authors.lastname: Reuveni
authors.forename: Asher
authors.initials: A
authors.lastname: Elahayani
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010372:Pediatrics / Q000592:standards; D010612:Pharyngitis / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D013290:Streptococcal Infections / Q000175:diagnosis
chemical_list: D000900:Anti-Bacterial Agents
keywords: Guidelines; Overuse of antibiotics; Pharyngitis; Primary physician; Sore throat