Sore throat (acute pharyngitis) is globally one of the most frequent
reasons for seeking healthcare. Its etiology is mostly viral. In 15-30%
of cases, group A streptococci (GAS) are detected, which may cause acute
rheumatic fever. We have done a worldwide systematic review to compare
diagnostic and therapeutic guidelines across countries and regions.
Previous reviews of sore throat guidelines were limited to specific
regions and/or language; this is the first global review. Searches were
performed in MEDLINE, EMBASE and COCHRANE (key words: sore throat,
pharyngitis, tonsillitis or pharyngotonsillitis, and management,
guidance, guideline or recommendation) and on the web sites of major
health authorities and associated institutions from Africa, Asia,
Europe, Middle East, North America, Oceania and South America.
Thirty-six guidelines were identified from 26 countries. Most common are
recommendations relying on the symptom- and age-based Centor or McIsaac
scores. However, antibiotic treatment may be based on other symptomatic
criteria; in the most extreme approach just sore throat in children. The
recommendation of GAS-specific diagnostic tests is mainly limited to
countries where such tests are readily available, although some
countries choose not to use them. Penicillins are consistently
recommended as first-line antibiotics. By contrast, guidance for
symptomatic treatment is variable and mostly sparse or missing. African
countries without sore throat guidelines and Asian countries bypassing
them are afflicted by rising antibiotic resistance. The availability of
sore throat guidelines varies considerably by region and country.
Moreover, important divergence is found among the guidelines regarding
diagnostic and treatment criteria. This may be explained by the
historical background or adoption of external guidelines, rather than
the local incidences of GAS infections or acute rheumatic fever. Absence
of recommendations on symptomatic treatment in many guidelines is
concerning, and raises issues about antimicrobial stewardship, as this
is the mainstay of sore throat management, rather than antibiotics.