Pharyngitis Complications in North America in the 21 st Century Do current guidelines lead to overdiagnosis and overtreatment Dr. Ian Johnston MBChB, BSc (Hons) Dr. James Dickinson, Dr. Carmen Gittens 1 st September 2015 CUMMING SCHOOL OF MEDICINE Department of Family Medicine
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Pharyngitis Complications in North America in the 21st CenturyDo current guidelines lead to overdiagnosisand overtreatment
Dr. Ian Johnston MBChB, BSc (Hons)
Dr. James Dickinson, Dr. Carmen Gittens1st September 2015
CUMMING SCHOOL OF MEDICINEDepartment of Family Medicine
Conflicts of Interest
None to disclose
Preventing Overdiagnosis – September 2015
Background
Acute Rheumatic Fever (ARF) — Immunologic sequelae— Group A streptococcus (GAS) infection— Can lead to Rheumatic Heart Disease (RHD).
ARF links to GAS pharyngitis established 1950s.— Warren Air Force Base (Southern Wyoming).
Studies supported antibiotic prescription to reduce incidence of ARF.
— Conclusions largely supported by recent Cochrane reviews. Two thirds reduction in chance of ARF with primary antibiotics.
Antibiotics/otitis media.— 1 in 14 children treated with antibiotics = adverse event
(vomiting/diarrhea/rash)Cochrane Database Syst Rev. 2013;(1). doi:10.1002/14651858.CD000219.pub2. International collaborative study of severe anaphylaxis.
Scottish study 1985- NNT of >100 000J R Coll Gen Pract. 1985;35(274):223-224. >7000 additional cases vomiting/diarrhea/rash 5-15 Anaphylactic/anaphylactoid reactions.
Preventing Overdiagnosis – September 2015
Discussion
7.3 Million pediatric sore throats annually (US data).— Antibiotics 53%. Not recommended ones 27% (increased resistance).
J Am Med Assoc. 2005;294(18):2315-2322. doi:10.1001/jama.294.18.2315.
~95% pharyngitis viral.— 20% of children asymptomatic chronic carriers of GAS.
Can Fam Physician. 2011;57(7):791–4. Clin Infect Dis. 2012;55(10):86–102. doi: 10.1093/cid/cis629
Clinical prediction rules don’t help decide who to swab.Can Med Assoc J. 2014;187(1):23-32. doi:DOI:10.1503 /cmaj.140772.
Preventing Overdiagnosis – September 2015
Further Work
CIHI currently re-running the numbers up to 2014 Including suppurative complications of GAS