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July 10, 2006

Pharyngitis Management: Focusing on Where We Agree

Arch Intern Med. 2006;166(13):1345-1346. doi:10.1001/archinte.166.13.1345

The recent literature on adult pharyngitis has focused on the controversy surrounding the approach to patients with severe pharyngitis. This debate contrasts empirical treatment for patients meeting specified clinical criteria with treatment only for those with microbiologic confirmation. Despite their differences, competing guidelines (one from the American College of Physicians–American Society of Internal Medicine1 and one from the Infectious Diseases Society of America [IDSA]2) agree on strategies for mild pharyngitis. Both guidelines use the pharyngitis score3 as an initial screen for adult patients who complain of an acute sore throat. Both guidelines recommend neither testing nor treating patients who have scores of 0 or 1 (the score is a simple sum of the following 4 factors: history of fever, lack of cough, swollen tender anterior cervical adenopathy, and tonsillar exudates). The guidelines then disagree about testing and empirical treatment for the patients with higher scores.

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