title: Choosing Wisely: The Top-5 Recommendations from the Italian Panel of the National Guidelines for the Management of Acute Pharyngitis in Children.
abstract: OBJECTIVE
  With the aim to reduce waste in the health care system and avoid risks associated with unnecessary treatment, the Italian Panel of the National Guidelines for the Management of Acute Pharyngitis in Children joined the Choosing Wisely initiative.
  
  
  METHODS
  An ad hoc Choosing Wisely task force was selected to develop a candidate list of items for the top-5 list on pharyngitis medicine. Through a process of literature review and consensus, the final list of 5 items was chosen. Drafted recommendations were formulated and then reviewed by the task force members until a final consensus was reached.
  
  
  RESULTS
  The 5 recommendations approved are: blood exams should not be performed; antibiotics should not be administrated unless microbiologic confirmation of streptococcal infection has been carried out; if a throat culture is performed, susceptibility tests on isolates should not be executed; antibiotic course should not be shortened; because penicillin V is not available in Italy, amoxicillin (50 mg/kg/d in 2-3 doses orally) for 10 days is the first choice treatment; and steroids should not be administered for the risk of masking possible underlying severe condition.
  
  
  CONCLUSIONS
  This top-5 list can be a novel tool to spread the key messages of guidelines and to avoid unnecessary diagnostic procedures, and to promote a rational use of antibiotics in children.
authors.affiliation: Anna Meyer Children׳s University Hospital, Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy. Electronic address: elena.chiappini@unifi.it.
authors.forename: Elena
authors.initials: E
authors.lastname: Chiappini
authors.affiliation: Anna Meyer Children׳s University Hospital, Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bortone
authors.affiliation: primary care pediatrician, Caserta, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Mauro
authors.affiliation: Department of Pediatrics, Santa Maria della Misericordia Hospital, University of Perugia, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Esposito
authors.affiliation: Anna Meyer Children׳s University Hospital, Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Galli
authors.affiliation: primary care pediatrician, Turin, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Landi
authors.affiliation: Department of Health Sciences, Section of Pharmacology, University of Florence, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Novelli
authors.affiliation: Department of Pediatrics, Santa Maria della Misericordia Hospital, University of Perugia, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Marchisio
authors.affiliation: Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Marseglia
authors.affiliation: Department of Pediatrics, Santa Maria della Misericordia Hospital, University of Perugia, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Principi
authors.affiliation: Anna Meyer Children׳s University Hospital, Department of Health Sciences, Section of Paediatrics, University of Florence, Florence, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: de Martino
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D006801:Humans; D007558:Italy; D010612:Pharyngitis / Q000188:drug therapy*; D013290:Streptococcal Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotics; children; choosing wisely; pharyngitis; streptococcal infections