My approach to acute pharyngitis 2018

First, we must define acute pharyngitis – no more than 3-5 days of symptoms. Second, we should understand that pre-adolescent pharyngitis has major differences form adolescent/you adult pharyngitis.( Mitchell, M. S., Sorrentino, A., & Centor, R. M. (2011). Adolescent pharyngitis: a review of bacterial causes. Clinical Pediatrics, 50(12), 1091–1095. http://doi.org/10.1177/0009922811409571 )  Here are the differences: Pre-adolescent pharyngitis really is group A strep vs viral Adolescent pharyngitis has a much broader differential – GAS, Group C/G strep, Fusobacterium necrophorum, infectious mononucleosis, acute HIV Antibiotics decrease duration of symptoms in adolescents but not pre-adolescents (Zwart, S., Sachs, A. P., Ruijs, G. J., Gubbels, J. W., Hoes, A. W., & de Melker, R. A. (2000). Penicillin for acute sore throat: randomised double blind trial of seven days versus three days treatment or placebo in adults. Bmj, 320(7228), 150–154. and (Zwart, S., Rovers, M. M., de Melker, R. A., & Hoes, A. W. (2003). Penicillin for acute sore throat in children: randomised, double blind trial. Bmj, 327(7427), 1324–1320. http://doi.org/10.1136/bmj.327.7427.1324) Current guidelines for children are logical.  Current guidelines for adolescent/adults follow from an assumption that I am happy to argue against. Third, all guidelines recommend neither testing nor treating Centor (or McIsaac modified) scores of 0 or 1.  The pre-test probabilities are very low...
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