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Differences Among International Pharyngitis Guidelines: Not Just Academic

Department of Family Medicine and Primary Health Care, Ghent University, Belgium

CORRESPONDENDING AUTHOR: Jan Matthys, MD, Department of Family Medicine and Primary Health Care, Ghent University, De Pintelaan 185, UZ-1K3, B-9000 Ghent, Belgium, jan.matthys{at}ugent.be

PURPOSE Many countries have national guidelines for the treatment of pharyngitis. We wanted to compare the recommendations and the reported evidence in national guidelines for the management of acute sore throat in adults.

METHODS Guidelines were retrieved via MEDLINE and EMBASE and through a Web-based search for guideline development organizations. The content of the recommendations and the underlying evidence were analyzed with qualitative and bibliometric methods.

RESULTS We included 4 North American and 6 European guidelines. Recommendations differ with regard to the use of a rapid antigen test and throat culture and with the indication for antibiotics. The North American, French, and Finnish guidelines consider diagnosis of group A streptococcus essential, and prevention of acute rheumatic fever remains an important reason to prescribe antibiotics. In 4 of the 6 European guidelines, acute sore throat is considered a self-limiting disease and antibiotics are not recommended. The evidence used to underpin these guidelines was different in North America and Europe. North American guidelines cited more North American references than did European guidelines (87.2% vs 48.0%; ods ratio, 4.6–11.9; P<.001).

CONCLUSION Although the evidence for the management of acute sore throat is easily available, national guidelines are different with regard to the choice of evidence and the interpretation for clinical practice. Also a transparent and standardized guideline development method is lacking. These findings are important in the context of appropriate antibiotic use, the problem of growing antimicrobial resistance, and costs for the community.

Key Words: Practice guideline [publication type] • acute sore throat • pharyngitis • primary health care • family practice • evidence-based medicine

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