, Volume 22, Issue 1, pp 127-130
Date: 18 Jan 2007

Pharyngitis Management: Defining the Controversy

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Despite numerous controlled trials, clinical practice guidelines and cost-effective analyses, controversy persists regarding the appropriate management strategy for adult pharyngitis. In this perspective, we explore this controversy by comparing two competing clinical guidelines. Although the guidelines appear to make widely diverging recommendations, we show that the controversy centers on only a small proportion of patients: those presenting with severe pharyngitis. We examine recently published data to illustrate that this seemingly simple problem of strep throat remains a philosophical issue: should we give primacy to relieving acute time-limited symptoms, or should we emphasize the potential societal risk of antibiotic resistance? We accept potentially over treating a minority of adult pharyngitis patients with the most severe presentations to reduce suffering in an approximately equal number of patients who will have false negative test results if the test-and-treat strategy were used.

We acknowledge that the designation severe pharyngitis is somewhat arbitrary. We have used the designation previously.15 Unpublished data support that patients with scores of 3 and 4 have more severe difficulty swallowing, which we equate with severity. Some patients with lower scores will consider their symptoms severe.