Article Figures & Data
Tables
Country (+ code) Organization Responsible for Guideline Development Web Sites of the Selected Guidelines Title in English Year of Publication (No. of Pages) Levels of Evidence or Grades of Recommendation Belgium (BE01)44 Scientific Organisation of Flemish GPs, WVVH http://www.health.fgov.be/antibiotics/ Acute Sore Throat: Guidelines for Good Clinical Practice 1999 (11) No The Netherlands (NL02)45 Dutch College of General Practitioners, NHG http://nhg.artsennet.nl Standard Acute Sore Throat 1999 (8) No France (FR03)46 Agence du Médicament http://agmed.sante.gouv.fr Antibiotic Therapy by General Way in General Practice: ENT Infections 1999 (8) Yes Finland47 (FI04) Duodecim http://www.guideline.gov Sore Throat and Tonsillitis 2001 (4) Yes England48 (E05) National Health Service, PRODIGY www.prodigy.nhs.uk Acute Sore Throat 2004 (9) Yes Scotland49 (SC06) Scottish Intercollegiate Guidelines Network (SIGN) www.sign.ac.uk Management of Sore Throat and Indications for Tonsillectomy 1999 (24) Yes Canada50 (CA07) Canadian Medical Association (CMA) http://www.hlth.gov.bc.ca Diagnosis and Management of Sore Throat 2001 (4) No United States51 (US08) Institute for Clinical Systems Improvement (ICSI) www.guideline.gov Acute Pharyngitis 2005 (33) Yes United States52 (US09) Infectious Disease Society of America (IDSA) www.guideline.gov Practice Guidelines for the Diagnosis and Management of Group A Streptococcal Pharyngitis 2002 (13) Yes United States53 (US10) American College of Physicians & American Society of Internal Medicine-Centers for Disease Control and Prevention (ACP/ASIM) www.guideline.gov Principles of Appropriate Antibiotic Use for Acute Pharyngitis in Adults (+ Background) 2001 (12) Yes European Guidelines North American Guidelines Diagnosis and Treatment Belgium44 BE01 The Netherlands45 NL02 France46 FR03 Finland47 FI04 England48 E05 Scotland49 SC06 Canada50 CA07 ICSI51 US08 IDSA52 US09 Position 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 + + + + + + + + + + - Table 3.
Type of Studies and European or American Articles Cited in the 10 Guidelines on Acute Sore Throat
Type of Study BE01 NL02 FR03 FI04 E05 SC06 CA07 US08 US09 US10 Total Cochrane, No. 1 1 0 3 2 0 1 0 0 1 9 Other systematic reviews, No. 9 6 4 1 4 5 0 4 0 1 34 Randomized controlled trial, No. 23 20 26 1 0 22 1 7 26 17 143 Guidelines, No. 1 4 4 0 5 2 1 2 7 3 29 Overview/others 43 54 35 0 5 44 9 26 63 50 329 Total cited, No. 77 85 69 5 16 73 12 39 96 72 544 European, No. (%) 35 (45.5) 46 (53.5) 27 (39.1) 1 (20.0) 13 (81.3) 31 (42.5) 0 1 (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) 0 1 (1.1) 1 (1.4) 19 (3.5)
Additional Files
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.