Clinical Infection in Practice (Jul 2024)
Management of sore throat (with focus on GAS) in young adults
Abstract
Background: Sore throat is a common presentation in primary care. Approximately 15 % of sore throat in adults are caused by Group A Streptococcus (GAS). Clinical guidelines for sore throat recommend prescribing antibiotics only when there is a high probability that the condition has been caused by GAS. Most guidelines incorporate clinical prediction rules (CPRs) such as the Centor Score. Objectives: To present the prevalence and management of sore throat in young adults, with a particular focus on sore throat caused by GAS, including antibiotic prescribing and the retrospective application of the Centor Score. Methods: This prospective observational cohort study included 348 young adults with sore throat presenting in student health centres between 2017 and 2019. A descriptive overview of symptoms in participants with and without GAS is presented, and potential associations between participant characteristics and symptoms and antibiotic prescription were explored using regression analysis. The Centor Score was retrospectively calculated and explored. Results: 23 % (80) of participants had a positive throat swab for GAS. 65 % (225/345) of all participants were prescribed immediate and 12 % (43/345) delayed antibiotics. The symptoms and clinical signs most associated with antibiotic prescribing were exudate on tonsils, absence of cough and enlarged or tender anterior cervical lymph nodes. A retrospective analysis of the Centor score was possible for 337 participants of whom 49 % had a low (score ≤ 2) and 48 % a high Centor score (>2). For 50 % of participants, prescribing was in line with National Institute for Clinical Excellence (NICE) clinical guidelines, i.e. a Centor score of 3 or 4. Conclusions: Overall, the prevalence of GAS (23 %) was higher than the predicted 15 % for this population. Antibiotic prescribing was high. As the recommended maximum level of antibiotic prescribing is 20 % for sore throat, this presents an opportunity for improvement. A potential strategy could combine high Centor scores with point of care testing.
