Usefulness of centor score for diagnosis of group A streptococcal pharyngo-tonsillitis and prevalence of the disease in Malaysia from 2016 to 2017
Pharyngo-tonsillitis is very common in general practice and most of the cases are caused by viruses. One of the causes of pharyngo-tonsillitis is group A streptococcus, which has a strong indication for antibiotic treatment. It is difficult to distinguish between streptococcal pharyngo-tonsilliti...
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| Format: | Thesis |
| Language: | English |
| Published: |
2017
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| Subjects: | |
| Online Access: | http://psasir.upm.edu.my/id/eprint/68566/1/FPSK%28M%29%202018%201%20-%20IR.pdf |
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| Summary: | Pharyngo-tonsillitis is very common in general practice and most of the cases are
caused by viruses. One of the causes of pharyngo-tonsillitis is group A streptococcus,
which has a strong indication for antibiotic treatment. It is difficult to distinguish
between streptococcal pharyngo-tonsillitis from non-streptococcal according to the
clinical findings. Nevertheless, up to 90% of the patients with sore throat might be
treated with antibiotic. Over prescribing of antibiotics has very serious health effects
with severe reactions and may promote antibiotic resistance and add significantly to
the cost of health care. In Malaysia, Upper Respiratory Tract Infection (URTI) makes
up nearly 30% of cases in primary care. Studies have shown trends of inappropriate
prescribing of antibiotics for URTI in Malaysian primary care. Centor scoring is a
guideline based on a set of criteria that help to identify the likelihood of streptococcal
infections in patients with a sore throat. It was conducted to guide physicians to
appropriately prescribe antibiotics for adults with pharyngo-tonsillitis. This study
aims to describe the epidemiological pattern, etiology and its antibiotic
susceptibility, clinical manifestation, antibiotic prescription among adults with sore
throat and validity of Centor score in diagnosis group A streptococcal pharyngotonsillitis
at three primary care clinics in Sepang, Selangor, Malaysia during 2016 to
2017. This cross-sectional study was conducted on 215 patients aged 18 and above
with sore throat as one of the complaints at the three primary care clinics during
December 2016 until April 2017. Throat swabs were collected from the patients for
culture and analysis. Data on clinical manifestations, demographic characteristics,
clinical information and throat sample results were analyzed using Chi-square test,
and descriptive statistics. From all the participants (42.3% male, 57.7% female),
(18.6% smokers, 81.4% non-smokers), (62.8%Malay, 30.2% Indian, 5.1% Chinese,
1.9 % others), 6 isolates (2.4%) were identified as GAS including 50% of those were
associated with Centor score of 3 (p < 0.001), 50% were associated with Centor score of 4 (p < 0.001), and 0% with Centor scores of 0,1 and 2. Centor criteria were clinical
predictors that associated with group A streptococcal pharyngo-tonsillitis (p <
0.001). Pharyngo-tonsillitis was diagnosed in 130 (60.5%) of the total adult
participants who complained with sore throat. Beta hemolytic streptococci and
influenza A and B viruses were isolated from 37.1% and 3.8 % of total participants,
respectively. Both Centor scores 3 and 4 had sensitivity of 50%, and specificity of
97.6% and 100%; respectively, positive predictive value 37.5% and 100%;
respectively, negative predictive value 98.6% and 98.6%; respectively, positive
likelihood ratio 20.5 and 50; respectively, negative likelihood ratio 0.5 and 0.5;
respectively. The accuracy of Centor score 3 was 96.3% while the accuracy of Centor
score 4 was 98.6%. Antibiotics were prescribed to 48 (22.3%) including 8.3% with
group A streptococcus and 91.6% with non-group A streptococcus. A majority of
prescribed antibiotics was associated with Centor scores of zero to one (75.0%).
Antibiotic susceptibility testing revealed that all beta hemolytic streptococci isolates
were susceptible to penicillin G, ampicillin, ofloxacin, cefepime, cefotaxime,
ceftriaxone, vancomycin, and linezolid, but 40%, 2.4%, and 9.6% were resistant to
tetracycline, clindamycin, and erythromycin, respectively. The current study has
suggested that the Centor score is useful for diagnosis and decision making for
antibiotic therapy of GAS pharyngo-tonsillitis leading to decrease the unnecessary
antibiotic prescription, while achieving better levels of treatment. |
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