Treatment of Adults With Acute Pharyngitis in Primary Care Practice

As members of the IDSA guideline committee on the management of GAS pharyngitis,¹ we read with interest the article by Linder et al² and editorial by Centor and Cohen³ regarding the management of adults with acute pharyngitis. As a point of clarification, we wish to point out that the article and editorial err in stating that the 4-point Centor criteria⁴ were explicitly recommended by the IDSA. We believe that clinical algorithms such as that of Centor et al⁴ can be most helpful in identifying patients whose risk of GAS pharyngitis is low enough to preclude the necessity of diagnostic testing. We do not, however, recommend their use in lieu of such testing in adult patients with sore throat, whose clinical findings are more highly suggestive of GAS infection. In this regard, we differ with the clinical practice guideline endorsed by the ACP.⁵ For example, Linder et al² found that 60% of their patients meeting the 4 Centor criteria, who could be treated empirically according to the ACP guideline, nevertheless had negative rapid antigen detection test results and/or throat cultures for GAS. We were gratified to read the authors' conclusion that “perfect adherence to the IDSA strategy would result in the lowest rate of antibiotic prescribing.”^2(p1378)