Centor’s Corner: Thoughts on Diagnosis and Management of Pharyngitis

Centaur Centor3 (1)
Centor’s
Corner

Current guidelines for children are logicalCurrent guidelines for adolescent/adults follow from an assumption that I am happy to argue against.

All guidelines recommend not to test or treat for Centor scores (with or without McIsaac modification) of 0 or 1. The pre-test probabilities are very low and most positive tests are false positives. Unfortunately, many urgent care centers and emergency departments perform a rapid strep test prior to the treating practitioner spending 3-5 minutes doing a quick history and exam. Testing wastes resources in 40-50% of patients presenting with a sore throat complaint and leads to unnecessary antibiotics. This is the biggest mistake that I see!

The controversy for adolescents/adults with pharyngitis and Centor scores of 2-4 involves the concept of lack of proof. Why treat pharyngitis with antibiotics? 

There are 5 potential reasons to treat pharyngitis with antibiotics: 

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