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Appropriately Prescribing Antibiotics for Patients With Pharyngitis: A Physician-Based Approach vs a Nurse-Only Triage and Treatment Algorithm

      OBJECTIVE

      To assess the safety and appropriateness of antibiotic use in adult patients with pharyngitis who opted for a nurse-only triage and treatment algorithm vs patients who underwent a physician-directed clinical evaluation.

      PATIENTS AND METHODS

      Using International Classification of Diseases, Ninth Revision codes to query the electronic medical record database at our institution, a large multispecialty health care system in LaCrosse, WI, we identified adult patients diagnosed as having pharyngitis from September 1, 2005, through August 31, 2007. Diagnosis, treatment, and outcome data were collected retrospectively.

      RESULTS

      Of 4996 patients who sought treatment for pharyngitis, 3570 (71.5%) saw a physician and 1426 (28.5%) opted for the nurse-only triage and treatment algorithm. Physicians adhered to antibiotic-prescribing guidelines in 3310 (92.7%) of 3570 first visits, whereas nurses using the algorithm adhered to guidelines in 1422 (99.7%) of 1426 first visits (P<.001). Physicians were significantly less likely to follow guidelines at patients' subsequent visits for a single pharyngitis illness than at their initial one (92.7% [3310/3570] vs 83.7% [406/485]; P<.001).

      CONCLUSION

      Instituting a simple nurse-only triage and treatment algorithm for patients presenting with pharyngitis appears to reduce unnecessary antibiotic use.
      GABHS (group A β-hemolytic streptococcus), IDSA (Infectious Diseases Society of America), RADT (rapid antigen detection test)
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      REFERENCES

        • Cooper RJ
        • Hoffman JR
        • Bartlett JG
        • et al.
        Principles of appropriate antibiotic use for acute pharyngitis in adults: background.
        Ann Emerg Med. 2001; 37: 711-719
        • Humair JP
        • Revaz SA
        • Bovier P
        • Stalder H
        Management of acute pharyngitis in adults: reliability of rapid streptococcal tests and clinical findings.
        Arch Intern Med. 2006; 166: 640-644
        • Bisno AL
        • Peter GS
        • Kaplan EL
        Diagnosis of strep throat in adults: are clinical criteria really good enough?.
        Clin Infect Dis. 2002; 35: 126-129
        • Bisno AL
        • Gerber MA
        • Gwaltney Jr, JM
        • Kaplan EL
        • Schwartz RH
        • Infectious Diseases Society of America
        Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis.
        Clin Infect Dis. 2002; 35: 113-125
        • Denny FW
        • Wannamaker LW
        • Brink WR
        • Rammelkamp Jr, CH
        • Custer EA
        Prevention of rheumatic fever: treatment of the preceding streptococcic infection.
        J Am Med Assoc. 1950; 143: 151-153
        • Webb KH
        • Needham CA
        • Kurtz SR
        Use of a high-sensitivity rapid strep test without culture confirmation of negative results: 2 years' experience.
        J Fam Pract. 2000; 49: 34-38
        • Linder JA
        • Stafford RS
        Antibiotic treatment of adults with sore throat by community primary care physicians: a national survey, 1989-1999.
        JAMA. 2001; 286: 1181-1186
        • Linder JA
        Antibiotics for treatment of acute respiratory tract infections: decreasing benefit, increasing risk, and the irrelevance of antimicrobial resistance [editorial].
        Clin Infect Dis. 2008; 47: 744-746
        • Butler CC
        • Rollnick S
        • Pill R
        • Maggs-Rapport F
        • Stott N
        Understanding the culture of prescribing: qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats.
        BMJ. 1998; 317: 637-642