Treating sore throats in the emergency room. The importance of follow-up in decision making

Pilot Survey of Knowledge, Attitudes and Perceptions of Hajj Deployed Health Care Workers on Antibiotics and Antibiotic Prescriptions for Upper Respiratory Tract Infections: Results from Two Hajj Seasons

Antimicrobial resistance (AMR) is a global public health issue. Upper respiratory tract infections (URTIs) are common illnesses during Hajj, for which antibiotics are often inappropriately prescribed. Hajj healthcare workers' (HCW) knowledge, attitudes and perceptions (KAP) about AMR and antibiotic use for URTIs are not known. We conducted a survey among HCWs during Hajj to explore their KAP regarding antibiotic use for URTIs in pilgrims. Electronic or paper-based surveys were distributed to HCWs during the Hajj in 2016 and 2017. A total of 85 respondents aged 25 to 63 (median 40) years completed the surveys. Most participants were male (78.8%) and were physicians by profession (95.3%). Around 85% and 19% of respondents claimed to have heard about AMR and antimicrobial stewardship programs, respectively, among whom most had obtained their knowledge during their qualification. Implementation of URTI treatment guidelines was very low. In conclusion, HCWs at Hajj have significant knowledge gaps regarding AMR, often do not use standard clinical criteria to diagnose URTIs and display a tendency to prescribe antibiotics for URTIs.

Upper respiratory infection: helpful steps for physicians

Upper respiratory infections (URIs) are extremely common in adults. Most adults have multiple URIs each year, with athletes being more or less susceptible, depending on training intensity. Most URIs are viral nasopharyngeal infections that will improve in 7 to 10 days with symptomatic treatment and result in little time lost from athletic participation. Physicians must recognize the symptoms consistent with bacterial pharyngitis, infectious mononucleosis, and sinusitis to provide appropriate diagnostic testing, treatment, and return-to-play recommendations.

What a difference a day makes: a decision analysis of adult streptococcal pharyngitis

With the availability of group A beta-hemolytic streptococcal (GABHS) antigen detection tests, the management of adult pharyngitis is being reassessed. A decision analytic model was developed which considered four strategies: immediate treatment, no treatment, performing a rapid antigen test, or obtaining a bacterial culture. Patient outcomes were expressed in "well" days, which were reduced by the "sick" days associated with adverse reactions to treatment or complications of GABHS infection. When immediate test results are available, testing is the optimal strategy for probabilities of GABHS between 1 and 49 per cent. This range includes almost all patients, using probability estimates based on clinical criteria. The absolute benefit of testing was 0.1 days. The major advantage of a rapid test is the avoidance of penicillin reactions. Variations in the symptomatic benefits of treatment had minimal effects on the analysis. The analysis supports the use of an antigen test for adult patients with pharyngitis.

Streptococcal pharyngitis in the emergency department: analysis of therapeutic strategies

Potential streptococcal pharyngitis represents a common presenting complaint of patients in emergency departments. Studies have shown that therapy within the first 48 hours of presentation hastens the resolution of the infection. A prior analysis of the cost of treatment for potential streptococcal pharyngitis in an outpatient practice suggested that when the likelihood of a positive throat culture is high, therapy is more cost effective without a throat culture. The current analysis evaluates the effects of emergency department charges, incomplete follow-up, and several common screening tests (Gram stain, clinical scoring) upon the cost of treatment and the risk for rheumatic fever. The results of the current analysis support the use of common screening tests to permit immediate oral or parenteral penicillin treatment of selected patients without a throat culture and the use of a throat culture to detect false-negative screen results.