Although Linder et al1 point out the poor compliance with either Infectious Diseases Society of America (IDSA) or American College of Physicians (ACP) guidelines for the treatment of pharyngitis, the question of why to treat and how to treat remains a debatable issue for many physicians. As pointed out by Centor and Cohen2 in the accompanying editorial, group C streptococcal infections may be missed by any method that relies solely on rapid testing, as may group G infections. Despite the widespread use of the 4 Centor criteria3 for aid in diagnosis, the usefulness of these criteria are questionable. Although pediatric pharyngitis presentations are sometimes different from those in adults, we can still learn from pediatric experience. Lin et al4 showed that the presence of fever, tonsillar exudate, and lack of cough were not reliable indicators of group A streptococcus (GAS) infection. Anterior adenopathy was the only one of the Centor criteria that had diagnostic significance. Wald et al5 showed that by using a 6-point score card, a predicted positive culture rate could be increased to 72%. However, even in the face of proven streptococcal pharyngitis, the best treatment is still questionable, as well as whether treatment is even required.
Westerman EL. Pharyngitis: How and Why. Arch Intern Med. 2006;166(20):2290–2291. doi:10.1001/archinte.166.20.2290