Journal of General Internal Medicine

, Volume 22, Issue 1, pp 127–130 | Cite as

Pharyngitis Management: Defining the Controversy

  • Robert Maccabee Centor
  • Jeroan Julius Allison
  • Stuart James Cohen

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.

Key words

streptococcal pharyngitis group C group A fusobacterium necrophorum lemierre’s disease tonsils guidelines 


Potential Financial Conflict of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Robert Maccabee Centor
    • 1
  • Jeroan Julius Allison
    • 1
  • Stuart James Cohen
    • 1
  1. 1.University of Alabama at BirminghamBirminghamUSA

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