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General practice / Family practice
Original research
What is the optimal strategy for managing primary care patients with an uncomplicated acute sore throat? Comparing the consequences of nine different strategies using a compilation of previous studies
  1. Ronny Gunnarsson1,2,3,4,
  2. Ulrich Orda5,
  3. Bradley Elliott6,
  4. Clare Heal7,
  5. Chris Del Mar8
  1. 1School of Public Health and Community Medicine - General Practice/Family Medicine, Göteborgs universitet Institutionen för medicin, Goteborg, Sweden
  2. 2Research, Development, Education and Innovation, Primary Health Care, Västra Götalandsregionen, Göteborg, Sweden
  3. 3Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Göteborg, Sweden
  4. 4The primary health care clinic for homeless people, Närhälsan, Region Västra Götaland, Göteborg, Sweden
  5. 5Mount Isa Hospital, North West Hospital and Health Service, Mount Isa, Queensland, Australia
  6. 6Hinchinbrook Health Care, Ingham, Queensland, Australia
  7. 7School of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia
  8. 8Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
  1. Correspondence to Professor Ronny Gunnarsson; ronny.gunnarsson{at}infovoice.se

Abstract

Objective Identifying optimal strategies for managing patients of any age with varying risk of acute rheumatic fever (ARF) attending for an apparently uncomplicated acute sore throat, also clarifying the role of point-of-care testing (POCT) for presence of group A beta-haemolytic Streptococcus (GABHS) in these settings.

Design We compared outcomes of adhering to nine different strategies for managing these patients in primary healthcare.

Setting and participants The nine strategies, similar to guidelines from several countries, were tested against two validation data sets being constructs from seven prior studies.

Main outcome measures The proportion of patients requiring a POCT, prescribed antibiotics, prescribed antibiotics having GABHS and finally having GABHS not prescribed antibiotics, if different strategies had been adhered to.

Results In a scenario with high risk of ARF, adhering to existing guidelines would risk many patients ill from GABHS left without antibiotics. Hence, using a POCT on all of these patients minimised their risk. For low-risk patients, it is reasonable to only consider antibiotics if the patient has more than low pain levels despite adequate analgesia, 3–4 Centor scores (or 2–3 FeverPAIN scores or 3–4 McIsaac scores) and a POCT confirming the presence of GABHS. This would require testing only 10%–15% of patients and prescribing antibiotics to only 3.5%–6.6%.

Conclusions Patients with high or low risk for ARF needs to be managed very differently. POCT can play an important role in safely targeting the use of antibiotics for patients with an apparently uncomplicated acute sore throat.

  • primary care
  • protocols & guidelines
  • public health

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. This publication builds upon previously published data sets compiled as described in the publication.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2021-059069

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as online supplemental information. This publication builds upon previously published data sets compiled as described in the publication.

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    Footnotes

    • Deceased Deceased after submission of revised manuscript

    • Contributors The initiative for this study comes from RG with input from UO. Details of the study were planned by RG with support from UO, BE, CH and CDM. RG conducted analysis of data and wrote a draft of the manuscript which was discussed and refined in discussion with all authors. All authors are guarantors taking full responsibility for the article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.