G65(P) Antibiotic use in acute pharyngitis in children

IntroductionGroup A Streptococci (GAS) accounts for 15–30% of acute pharyngitis in children1 and is most prevalent in children older than 3 years of age.2 AimsThe aim of this audit was to identify the percentage of children with acute pharyngitis who had throat cultures taken and if they received antibiotics. The audit aimed to identify clinical signs in acute pharyngitis that could predict GAS pharyngitis.MethodsRetrospective case notes review of children aged between 1 and 15 years attending the assessment unit with fever and sore throat was performed from January to March 2015. Children with other diagnoses were excluded. Data was obtained on the following signs of pharyngitis: presence of fever, cough, tonsillar swelling/exudate and tender cervical lymph nodes. Details regarding throat culture results and antibiotics prescribed was also collected.ResultsA total of 129 children aged 1–15 years attended the unit during this period. 82 had other diagnoses including non-specific viral illness, croup, otitis media. 47 had acute pharyngitis, of which 40 had throat cultures collected (85%). 29 of these children (72%) received antibiotics. The reason for collecting cultures in 28 (70%) was presence of tonsillar exudate. GAS was identified in 7 cases (17%), all received antibiotics but only 2 had appropriate oral Penicillin for 10 days3 (Figure 1). Viral growth was seen in 11 cases, 7 were prescribed antibiotics based on clinical assessment. 2 children had GAS with viral growth and received antibiotics. The remaining cultures were negative and 83% received antibiotics (20). The presence of clinical signs and chances of GAS pharyngitis is summarised in Table 1.Abstract G65(P) Figure 1Throat culture results and treatment receivedAbstract G65(P) Table 1Clinical signs and throat culture resultsConclusionsThe results show that the majority of children presenting with fever and sore throat had throat cultures collected but the indication was identified in 70% of cases. Our results show that, in the presence of 4 clinical signs, it is more likely to have GAS pharyngitis. Introducing a simple score in primary and secondary care, such as McIsaac score4, could help reducing unnecessary antibiotic prescribing for acute pharyngitis and development of antibiotic resistance (Figure 2).Abstract G65(P) Figure 2McIsaac score