Current guidelines for children are logical. Current 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:
Brandon Webb, MD, is an infectious disease physician in the division of epidemiology and infectious diseases at Intermountain Healthcare in Utah. He has also served as an adjunct assistant professor at the University of Utah School of Medicine. Dr. Webb’s research interests include bacterial pneumonia, antimicrobial stewardship, and transplant infectious diseases.
Antibiotic overuse and misuse is a growing public health concern, and foregoing the administration of antibiotics in cases where they are not needed can be a challenging decision to defend without good evidence to back it up. The Centor Score for Strep Pharyngitis is one of the most practical and useful evidence-based decision tools that helps support clinicians in making those decisions. We interviewed Dr. Robert Centor on developing and using the Centor Score.
Why did you develop the Centor Score? Was there a clinical experience that inspired you to create this tool for clinicians?
In 1979, while working in the “non-acute” adult emergency room, a resident asked me how to evaluate a sore throat patient. Having just finished my residency, I started to give a definitive answer, but had a moment of humility and told him that I did not know. We made a treatment decision at the time, and I went to the library to learn more. Continue reading “Insights from Dr. Robert M. Centor, Creator of the Centor Score for Strep Pharyngitis”→