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

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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: 

Continue reading “Centor’s Corner: Thoughts on Diagnosis and Management of Pharyngitis”

Insights from Dr. Robert M. Centor, Creator of the Centor Score for Strep Pharyngitis

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.

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Why did you develop the Centor Score? Was there a clinical experience that inspired you to create a 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”