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Research ArticleSystematic Reviews

Differences Among International Pharyngitis Guidelines: Not Just Academic

Jan Matthys, Marc De Meyere, Mieke L. van Driel and An De Sutter
The Annals of Family Medicine September 2007, 5 (5) 436-443; DOI: https://doi.org/10.1370/afm.741
Jan Matthys
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Marc De Meyere
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Mieke L. van Driel
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An De Sutter
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    Table 1.

    Characteristics of Selected Guidelines on Acute Sore Throat

    Country (+ code)Organization Responsible for Guideline DevelopmentWeb Sites of the Selected GuidelinesTitle in EnglishYear of Publication (No. of Pages)Levels of Evidence or Grades of Recommendation
    Belgium (BE01)44Scientific Organisation of Flemish GPs, WVVHhttp://www.health.fgov.be/antibiotics/Acute Sore Throat: Guidelines for Good Clinical Practice1999 (11)No
    The Netherlands (NL02)45Dutch College of General Practitioners, NHGhttp://nhg.artsennet.nlStandard Acute Sore Throat1999 (8)No
    France (FR03)46Agence du Médicamenthttp://agmed.sante.gouv.frAntibiotic Therapy by General Way in General Practice: ENT Infections1999 (8)Yes
    Finland47 (FI04)Duodecimhttp://www.guideline.govSore Throat and Tonsillitis2001 (4)Yes
    England48 (E05)National Health Service, PRODIGYwww.prodigy.nhs.ukAcute Sore Throat2004 (9)Yes
    Scotland49 (SC06)Scottish Intercollegiate Guidelines Network (SIGN)www.sign.ac.ukManagement of Sore Throat and Indications for Tonsillectomy1999 (24)Yes
    Canada50 (CA07)Canadian Medical Association (CMA)http://www.hlth.gov.bc.caDiagnosis and Management of Sore Throat2001 (4)No
    United States51 (US08)Institute for Clinical Systems Improvement (ICSI)www.guideline.govAcute Pharyngitis2005 (33)Yes
    United States52 (US09)Infectious Disease Society of America (IDSA)www.guideline.govPractice Guidelines for the Diagnosis and Management of Group A Streptococcal Pharyngitis2002 (13)Yes
    United States53 (US10)American College of Physicians & American Society of Internal Medicine-Centers for Disease Control and Prevention (ACP/ASIM)www.guideline.govPrinciples of Appropriate Antibiotic Use for Acute Pharyngitis in Adults (+ Background)2001 (12)Yes
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    Table 2.

    Comparison of the Recommendations in Acute Sore Throat Guidelines

    European GuidelinesNorth American Guidelines
    Diagnosis and TreatmentBelgium44 BE01The Netherlands45 NL02France46 FR03Finland47 FI04England48 E05Scotland49 SC06Canada50 CA07ICSI51 US08IDSA52 US09Position Paper (ACP)53 US10
    ACP = American College of Physicians; ARF = acute rheumatic fever; GABHS = group A β-hemolytic streptococci; GNF = glomerulonephritis; ICSI = Institute for Clinical Systems Improvement; ISDA = Infectious Disease Society of America.
    * If a rapid antigen (strep) test is not available.
    Diagnosis
        History++++++++++
        Clinical examination++++++++++
        Centor criteria−−−−−−++++
        GABHS (rapid antigen or strep) test−−++−−−+++
        Culture−−−+−−++*+*−
    Treatment
        Prescribe antibiotics
            High-risk and very ill patients+++−++++++
            Centor criteria−−−−−−−−−+
            GABHS test result positive−−++−−−+++
            GABHS test result negative; culture positive−−++−−−++−
            Culture positive−−−+−−+++−
    Reason for antibiotics
        Shorten clinical evolution++++−−++++
        Prevent ARF−−++−−++++
        Prevent GNF−−−−−−−−−−
        Prevent local complications−−−−−−+−++
        Limit spread of GABHS−+++++++++
    Small-spectrum penicillin++++++++++
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    Table 3.

    Type of Studies and European or American Articles Cited in the 10 Guidelines on Acute Sore Throat

    Type of StudyBE01NL02FR03FI04E05SC06CA07US08US09US10Total
    Cochrane, No.11032010019
    Other systematic reviews, No.964145040134
    Randomized controlled trial, No.2320261022172617143
    Guidelines, No.144052127329
    Overview/others43543505449266350329
    Total cited, No.7785695167312399672544
    European, No. (%)35 (45.5)46 (53.5)27 (39.1)1 (20.0)13 (81.3)31 (42.5)01 (2.6)3 (3.1)21 (29.2)178 (32.7)
    American, No. (%)40 (52.0)36 (41.9)39 (56.5)1 (20.0)2 (12.5)38 (52.1)11 (91.7)38 (97.4)92 (95.8)50 (69.4)347 (63.8)
    Other, No. (%)2 (2.5)3 (4.6)3 (4.4)3 (60.0)1 (6.2)4 (5.4)1 (8.3)01 (1.1)1 (1.4)19 (3.5)

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  • The Article in Brief

    Differences Among International Pharyngitis Guidelines: Not Just Academic.

    Jan Matthys, MD , and colleagues

    Background This study compares recommendations and reported evidence in guidelines for managing sore throat in adults. Four North American and 6 European guidelines were included in the study.

    What This Study Found The recommendations differ from one another in terms of testing for and treating sore throat. In France, North America, or Finland, a diagnostic test will be performed and the treatment depends on its result. In England, Scotland, Belgium, or the Netherlands, doctors will not use a test, and the decision to prescribe penicillin depends mainly on the severity of the patient�s illness. The evidence used to support these guidelines is different in North America and Europe. North American guidelines cite more North American references than do European guidelines.

    Implications

    • Differences among guidelines have important consequences for medical practice. A patient seeing a family physician for acute sore throat will be managed differently according to country.
    • Both approaches to diagnosing and treating sore throat found in this study are based on scientific evidence. The differences seem to be related to selection and/or interpretation of information.
    • The authors suggest that introducing a method for developing guidelines in Europe and North American may lead to more uniformity in diagnosing and managing sore throat.
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Vol. 5, Issue 5
1 Sep 2007
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Differences Among International Pharyngitis Guidelines: Not Just Academic
Jan Matthys, Marc De Meyere, Mieke L. van Driel, An De Sutter
The Annals of Family Medicine Sep 2007, 5 (5) 436-443; DOI: 10.1370/afm.741

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Differences Among International Pharyngitis Guidelines: Not Just Academic
Jan Matthys, Marc De Meyere, Mieke L. van Driel, An De Sutter
The Annals of Family Medicine Sep 2007, 5 (5) 436-443; DOI: 10.1370/afm.741
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