Untreated group A streptococcal (GAS) sore throats can cause acute rheumatic fever (ARF), with permanent cardiac damage in 30%. An algorithm and guideline for appropriate screening and management of sore throats in the New Zealand setting was crafted to guide appropriate treatment in high risk rheumatic fever areas and reduce antibiotic use in low risk areas.
Three American sore throat guidelines were used as a framework, and searches were made of databases including Medline, Old Medline, Cochrane, DARE, Central, NHS EED, WHOLIS, (www.clinicalevidence.com), and (www.pubmed.gov). No European guidelines were available.
A guideline for GAS pharyngitis was created, including an algorithm which stratifies patients according to their risk of ARF. Revised Centor criteria to determine the likelihood of GAS pharyngitis were used. Patients at medium or high risk for GAS pharyngitis should have throat swabs taken if possible. Recommended treatment tables are given.
Patients presenting with sore throats need to have their risk of developing rheumatic fever assessed, and then the risk of GAS pharyngitis determined. Appropriate antibiotic therapy is instigated on the basis of proven or likely GAS pharyngitis. Ten days of oral penicillin V is the first-line treatment. Other household members are at high risk of infection. Unnecessary antibiotic use is a guiding principle in low risk patients.