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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Principles of appropriate antibiotic use for acute pharyngitis in adults: background.Ann Emerg Med. 2001; 37: 711-719
- Management of acute pharyngitis in adults: reliability of rapid streptococcal tests and clinical findings.Arch Intern Med. 2006; 166: 640-644
- Diagnosis of strep throat in adults: are clinical criteria really good enough?.Clin Infect Dis. 2002; 35: 126-129
- Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis.Clin Infect Dis. 2002; 35: 113-125
- Prevention of rheumatic fever: treatment of the preceding streptococcic infection.J Am Med Assoc. 1950; 143: 151-153
- Use of a high-sensitivity rapid strep test without culture confirmation of negative results: 2 years' experience.J Fam Pract. 2000; 49: 34-38
- Antibiotic treatment of adults with sore throat by community primary care physicians: a national survey, 1989-1999.JAMA. 2001; 286: 1181-1186
- 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
- Understanding the culture of prescribing: qualitative study of general practitioners' and patients' perceptions of antibiotics for sore throats.BMJ. 1998; 317: 637-642
Article Info
Identification
Copyright
© 2010 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
