title: Empirical validation of Polish guidelines for the management of acute streptococcal pharyngitis in children.
abstract: OBJECTIVE
  Group A Streptococcus (GAS) pharyngitis is currently the only commonly occurring form of acute pharyngitis for which antibiotic therapy is definitely indicated. Polish guidelines advocate the use of modified Centor score (MCS) to assess the probability of GAS pharyngitis. They advise performing throat culture or rapid antigen detection test (RADT) in children with score 2-3 in MCS and treating with antibiotic only those in whom GAS was detected. Negative RADT results should be confirmed by culture. In children with score 4, the guidelines allow to introduce empiric antibiotic therapy. Phenoxymethyl penicillin is recommended as a drug of choice to treat GAS pharyngitis. The aim of our study was to evaluate the accuracy of strategy recommended by Polish guidelines in identifying those children with acute pharyngitis who require antibiotic treatment. Hence, diagnostic values of score 4 in MCS and RADT were assessed using throat culture as a reference standard. Phenoxymethyl penicillin efficacy in GAS eradication and prevention of post-streptococcal complications were estimated as well.
  
  
  METHODS
  Ninety children between 2 and 15 years of age with acute pharyngitis symptoms suggesting GAS etiology (MCS ≥ 2), participated in our study. At the initial visit MCS was evaluated and two throat swabs were collected to perform RADT and culture. In children with GAS pharyngitis treated with penicillin, microbiological cure was assessed by performing two control throat cultures. Next, children were under observation for 3 months.
  
  
  RESULTS
  Positive predictive value of score 4 in MCS turned out to be 48.05% (95% CI: 36.5-59.7%). RADT sensitivity, specificity and diagnostic accuracy proved to be 100%, 96%, and 98%, respectively. GAS eradication rate in children treated with penicillin turned out to be 92.5%. No post-streptococcal sequelae occurred in any child in 3-month observation.
  
  
  CONCLUSIONS
  Empiric antibiotic therapy in children with score 4 in MCS will result in significant overtreatment of those with nonstreptococcal pharyngitis. New generation RADT diagnostic value in GAS detection proved to be equivalent to that of culture, which obviates the need of backup culture in children with negative RADT results. Phenoxymethyl penicillin revealed high eradication efficacy and proved to prevent post-streptococcal sequelae in children with acute GAS pharyngitis.
authors.affiliation: Medical Microbiology Department, Medical University of Lublin, ul. Chodźki 1, 20-093 Lublin, Poland. Electronic address: elamazur@yahoo.com.
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Mazur
authors.affiliation: Specjalistyka Czechów Medical Center, ul. Kompozytorów Polskich 8, 20-848 Lublin, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Bochyńska
authors.affiliation: Pharmaceutical Microbiology Department, Medical University of Lublin, ul. Chodźki 1, 20-093 Lublin, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Juda
authors.affiliation: Medical Microbiology Department, Medical University of Lublin, ul. Chodźki 1, 20-093 Lublin, Poland.
authors.forename: Maria
authors.initials: M
authors.lastname: Kozioł-Montewka
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010406:Penicillins / Q000627:therapeutic use*; D010612:Pharyngitis / Q000188:drug therapy* / Q000382:microbiology; D011044:Poland; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins
keywords: Group A Streptococcus; Modified Centor score; Penicillin; Rapid antigen detection test; Throat culture