Abstract
Background
The Finnish Current Care Guidelines on diagnostics and treatment of sore throat recommend the treatment of only group A streptococcus (GAS) positive cases with penicillin. The aim of the study was to evaluate how these guidelines are followed in the pediatric emergency unit.
Methods
We analyzed retrospectively the data on microbiological studies and blood tests done, and data on prescribing of antibiotics, of 200 children admitted for febrile exudative tonsillitis.
Results
After the clinical diagnosis of exudative tonsillitis, antigen test and/or culture for GAS identification was done in >95% of cases. All the 32 (16%) children with GAS infection, but also 52 (38%) of the 137 children without any evidence of bacterial infection received antibiotics. Additional laboratory studies were done in 96% of children. Serum C-reactive concentrations or white blood cell counts were not able to separate streptococcal from non-streptococcal tonsillitis. No serious bacterial infection was diagnosed.
Conclusions
The Finnish Current Care Guidelines lead to over-treatment with antibiotics. None of the 200 children returned after discharge, suggesting that undertreatment did not happen.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a metaanalysis. Pediatrics 2010;126:e557–e564.
Putto A. Febrile exudative tonsillitis: viral or streptococcal? Pediatrics 1987;80:6–12.
Eison TM, Ault BH, Jones DP, Chesney RW, Wyatt RJ. Poststreptococcal acute glomerulonephritis in children: clinical features and pathogenesis. Pediatr Nephrol 2011;26:165–180.
Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST, et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation 2009;119:1541–1551.
Risberg S, Engfeldt P, Hugosson S. Incidence of peritonsillar abscess and relationship to age and gender: retrospective study. Scand J Infect Dis 2008;40:792–796.
Working group appointed by the Finnish Medical Society Duodecim, the Finnish Association for Central Practice, the Finnish Otolaryngological Society, Infectious Diseases Society of Finland and the Clinical Microbiologists Society. Current Care guideline (summary in English) 2012. http://www.kaypahoito.fi/web/kh/suositukset/naytaartikkeli/tunnus/ccs00095 (accessed January 9, 2014).
National Institute for Health and Clinical Excellence (NICE). Respiratory tract infections-antibiotic prescribing. Prescribing antibiotics for self-limiting respiratory tract infections in adults and children in primary care (clinical guideline 69). London: NICE, 2008. http://www.nice.org.uk/nicemedia/pdf/CG69FullGuideline.pdf (accessed January 9, 2014).
Scottish Intercollegiate Guidelines Network. Management of sore throat and indication for tonsillectomy (National Clinical Guideline 117) 2010. http://www.sign.ac.uk/pdf/sign117.pdf (accessed January 9, 2014).
Bisno AL, Gerber MA, Gwaltney JM Jr, Kaplan EL, Schwartz RH; Infectious Diseases Society of America. Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America. Clin Infect Dis 2002;35:113–125.
Aalbers J, O’Brien KK, Chan WS, Falk GA, Teljeur C, Dimitrov BD, et al. Predicting streptococcal pharyngitis in adults in primary care: a systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score. BMC Med 2011;9:67.
Fine AM, Nizet V, Mandl KD. Large-scale validation of the Centor and McIsaac scores to predict group A streptococcal pharyngitis. Arch Intern Med 2012;172:847–852.
Peltola HO. C-reactive protein for rapid monitoring of infections of the central nervous system. Lancet 1982;1:980–982.
Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 2004;39:206–217.
Putto A, Meurman O, Ruuskanen O. C-reactive protein in the differentiation of adenoviral, Epstein-Barr viral and streptococcal tonsillitis in children. Eur J Pediatr 1986;145:204–206.
Elsammak M, Hanna H, Ghazal A, Edeen FB, Kandil M. Diagnostic value of serum procalcitonin and C-reactive protein in Egyptian children with streptococcal tonsillopharyngitis. Pediatr Infect Dis J 2006;25:174–176.
Dominguez O, Rojo P, de Las Heras S, Folgueira D, Contreras JR. Clinical presentation and characteristics of pharyngeal adenovirus infections. Pediatr Infect Dis J 2005;24:733–734.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kunnamo, A., Korppi, M. & Helminen, M. Tonsillitis in children: unnecessary laboratory studies and antibiotic use. World J Pediatr 12, 114–117 (2016). https://doi.org/10.1007/s12519-015-0054-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12519-015-0054-y