The treatment of acute sore throat in Norway may be improved in several aspects, according to present knowledge.
• Antibiotics should be prescribed on the basis of clinical examination.
• Antibiotics should be avoided in probably viral infections.
• Broad spectrum antibiotics should be avoided.
• Penicillin V should be used in low dosage.
• Treatment should extend to 10 days.
Infections due to group A beta haemolytic streptococcus (GAS) should be diagnosed and treated. Patient with viral infections should receive adequate advice, but no antibiotics.
In 1994, a Nordic therapy workshop produced recommendations on the handling of acute sore throat. The indicators are to a large extent based on these conclusions. However, the indicators are developed to enable practitioners to assess the quality of local routines, even if they differ from the proposition. Such local adaptations should be written and reasons given.
The aim is to identify the GAS-infected patients. Clinical examination should be used to assess the probability of GAS infection, but sensitivity has not been reported to exceed 64 %. Scoring systems combining clinical findings, laboratory findings and age have been shown to increase sensitivity, but specificity remains low with a low prevalence of GAS. In Scandinavia, most studies have shown GAS to be present in 20-30 % of patients with acute sore throat.
In practice it is recommended to sort patients into three levels of probability for GAS infection based on clinical evaluation (table 1). The evaluation is influenced by the epidemiological situation, the age of the patient, and the properties of the streptococcus antigen test.
These report how organisation and equipment in the office enable optimal diagnostics.
• Does the office have guidelines for the care of patients with sore throat?
• Is the streptococcus antigen test provided, as well as routines for its use?
• Is the mononucleosis quick test provided as well as routines for its use?
• Are there equipment and routines for sending cultures to a microbiology laboratory?
These show how patients are worked up and treated in accordance with aims.
• Is there a positive antigen test or are clinical criteria (Table 2) fulfilled for GAS infection when antibiotics have been given to patients and the ICPC diagnoses are R72 or R76?
• If other antibiotics have been given than Penicillin V, is allergy or relapse present?
• Is the duration of the antibiotics course adequate?
• Is the dosage of antibiotics adequate?
These show the effect of treatment. The patients should be instructed to report back to the office if they do not improve.
• Has the patient reported back after 3-4 days that her condition is unchanged or worse despite treatment with antibiotics?
• Has a relapse been recorded within two weeks after the start of treatment?
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