Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study
<p>Abstract</p> <p>Background</p> <p>Although <it>Group A beta hemolytic streptococcus (GABHS)</it> can cause bacterial pharyngitis, the most common etiology is viral; despite this viral etiology, antibiotics are commonly prescribed for this infection in ind...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2012-11-01
|
| Series: | BMC Pulmonary Medicine |
| Subjects: | |
| Online Access: | http://www.biomedcentral.com/1471-2466/12/70 |
| _version_ | 1811299380186054656 |
|---|---|
| author | Palla Amber Khan Rafeeq Gilani Anwar H Marra Fawziah |
| author_facet | Palla Amber Khan Rafeeq Gilani Anwar H Marra Fawziah |
| author_sort | Palla Amber |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Although <it>Group A beta hemolytic streptococcus (GABHS)</it> can cause bacterial pharyngitis, the most common etiology is viral; despite this viral etiology, antibiotics are commonly prescribed for this infection in industrialized countries. We investigated the prevalence of <it>GABHS</it> in adult pharyngitis patients from lower socioeconomic settings in Karachi, Pakistan, how often antibiotics are prescribed for pharyngitis and if appropriate agents were used in a developing world setting. Finally, we wanted to see the usefulness of modified McIsaac scores in predicting positive cultures.</p> <p>Methods</p> <p>Adult patients were recruited from three local hospital outpatient dispensaries (OPDs). All patients aged 14–65 years who were suspected of having bacterial pharyngitis had throat swabs taken. Laboratory results for <it>GABHS</it> pharyngitis were then compared with their prescriptions. Appropriateness (using the World Health Organization’s definition) and type of antibiotic prescribed were assessed.</p> <p>Results</p> <p>Of 137 patients<b>,</b> 30 patients each were studied for scores of 0, 1, 2 and 3; 17 patients were studied for score 4. Although 6 (4.4%) patients were <it>GABHS</it>+, for a prevalence of 43.8 per 1000 population, antibiotics were prescribed to 135 patients (98.5%). Of these, only 11.1% received appropriate antibiotics while 88.9<b>%</b> received inappropriate antibiotics<b>.</b> Penicillins were prescribed most (34.1%), especially amoxicillin/clavulanate; followed by macrolides (31.1%), especially the second-generation agents, and fluoroquinolones (14.8%). McIsaac scores were found to be 100% sensitive and 68.7% specific, giving a positive predictive value (PPV) of 12.7% and a negative predictive value (NPV) of 100%.</p> <p>Conclusions</p> <p>Antibiotics were prescribed irrationally to adult pharyngitis patients, as most cultures were negative for bacterial infection. McIsaac modification of Centor scores related directly to culture results. We would therefore highly recommend its use to help family physicians make treatment decisions for adult pharyngitis patients.</p> |
| first_indexed | 2024-04-13T06:35:12Z |
| format | Article |
| id | doaj.art-fb247e1758e04daea3386989d1fcc292 |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-04-13T06:35:12Z |
| publishDate | 2012-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-fb247e1758e04daea3386989d1fcc2922022-12-22T02:57:57ZengBMCBMC Pulmonary Medicine1471-24662012-11-011217010.1186/1471-2466-12-70Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional studyPalla AmberKhan RafeeqGilani Anwar HMarra Fawziah<p>Abstract</p> <p>Background</p> <p>Although <it>Group A beta hemolytic streptococcus (GABHS)</it> can cause bacterial pharyngitis, the most common etiology is viral; despite this viral etiology, antibiotics are commonly prescribed for this infection in industrialized countries. We investigated the prevalence of <it>GABHS</it> in adult pharyngitis patients from lower socioeconomic settings in Karachi, Pakistan, how often antibiotics are prescribed for pharyngitis and if appropriate agents were used in a developing world setting. Finally, we wanted to see the usefulness of modified McIsaac scores in predicting positive cultures.</p> <p>Methods</p> <p>Adult patients were recruited from three local hospital outpatient dispensaries (OPDs). All patients aged 14–65 years who were suspected of having bacterial pharyngitis had throat swabs taken. Laboratory results for <it>GABHS</it> pharyngitis were then compared with their prescriptions. Appropriateness (using the World Health Organization’s definition) and type of antibiotic prescribed were assessed.</p> <p>Results</p> <p>Of 137 patients<b>,</b> 30 patients each were studied for scores of 0, 1, 2 and 3; 17 patients were studied for score 4. Although 6 (4.4%) patients were <it>GABHS</it>+, for a prevalence of 43.8 per 1000 population, antibiotics were prescribed to 135 patients (98.5%). Of these, only 11.1% received appropriate antibiotics while 88.9<b>%</b> received inappropriate antibiotics<b>.</b> Penicillins were prescribed most (34.1%), especially amoxicillin/clavulanate; followed by macrolides (31.1%), especially the second-generation agents, and fluoroquinolones (14.8%). McIsaac scores were found to be 100% sensitive and 68.7% specific, giving a positive predictive value (PPV) of 12.7% and a negative predictive value (NPV) of 100%.</p> <p>Conclusions</p> <p>Antibiotics were prescribed irrationally to adult pharyngitis patients, as most cultures were negative for bacterial infection. McIsaac modification of Centor scores related directly to culture results. We would therefore highly recommend its use to help family physicians make treatment decisions for adult pharyngitis patients.</p>http://www.biomedcentral.com/1471-2466/12/70AntibioticsPharyngitisMcIsaac-modified Centor scoreAntibiotic prescribingPakistan |
| spellingShingle | Palla Amber Khan Rafeeq Gilani Anwar H Marra Fawziah Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study BMC Pulmonary Medicine Antibiotics Pharyngitis McIsaac-modified Centor score Antibiotic prescribing Pakistan |
| title | Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study |
| title_full | Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study |
| title_fullStr | Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study |
| title_full_unstemmed | Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study |
| title_short | Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study |
| title_sort | over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using mcisaac modification of centor scores a cross sectional study |
| topic | Antibiotics Pharyngitis McIsaac-modified Centor score Antibiotic prescribing Pakistan |
| url | http://www.biomedcentral.com/1471-2466/12/70 |
| work_keys_str_mv | AT pallaamber overprescriptionofantibioticsforadultpharyngitisisprevalentindevelopingcountriesbutcanbereducedusingmcisaacmodificationofcentorscoresacrosssectionalstudy AT khanrafeeq overprescriptionofantibioticsforadultpharyngitisisprevalentindevelopingcountriesbutcanbereducedusingmcisaacmodificationofcentorscoresacrosssectionalstudy AT gilanianwarh overprescriptionofantibioticsforadultpharyngitisisprevalentindevelopingcountriesbutcanbereducedusingmcisaacmodificationofcentorscoresacrosssectionalstudy AT marrafawziah overprescriptionofantibioticsforadultpharyngitisisprevalentindevelopingcountriesbutcanbereducedusingmcisaacmodificationofcentorscoresacrosssectionalstudy |