Best practices: Talking to your patients about pharyngitis testing

According to Michigan Quality Consortium (MQIC) guidelines for acute pharyngitis, viruses account for 70-80% of pharyngitis in children, while Group A Streptococcal Pharyngitis only accounts for 20-30% of cases. That’s why it’s critical to ensure that your patients between the ages of 3 and 18 receive appropriate testing for streptococcus pharyngitis, prior to being diagnosed and treated with antibiotics.

We know this can be a challenging conversation to navigate with your patients, who may insist on antibiotics when they’re not needed or may not understand the difference between viral and bacterial infections.

Helpful tips for educating your patients

If a patient tests negative for group A strep but insists on an antibiotic:

  •  Refer to the illness as a sore throat due to a cold; patients tend to associate the label with a less-frequent need for antibiotics.
  • Write a prescription for symptom relief like over-the-counter medicines.

Educate patients on the difference between bacterial and viral infections.

Discuss with patients ways to manage symptoms. For example:

  • Get extra rest
  • Drink plenty of fluids
  • Use over-the-counter medications
  • Use a cool-mist vaporizer and nasal spray for congestion
  • Eat ice chips or use throat spray or lozenges for sore throats

Educate patients and their parents or caregivers that they can prevent infection by:

  • Washing hands frequently
  • Keeping an infected person's eating utensils and drinking glasses separate from other family members
  • Thoroughly washing an infected toddler's toys in hot water with disinfectant soap
  • Keeping a child diagnosed with a sore throat out of school or day care until he or she has taken antibiotics for at least 24 hours and until symptoms improve

Finally, document the performance of a rapid strep test or the parent or caregivers' refusal of testing in medical records.

CDC Principles of Appropriate Testing

Diagnosis CDC Principles of Appropriate Testing
Pharyngitis

Diagnose as Group A Streptococcal Pharyngitis using a lab test in conjunction with Clinical epidemiological findings

Antibiotics should not be given to a child with Pharyngitis in the absence of diagnosed Group A streptococcal infection 

A penicillin remains the drug of choice for treating Group A Streptococcal Pharyngitis

Additional resources

For more information, see the MQIC Guidelines for assessing, diagnosing and treating Acute Pharyngitis.

Additional information can also be found on the American Academy of Pediatrics website.