PATRYCJA WOLDAN-GRADALSKA: The management of pharyngotonsillitis to ensure optimal antibiotic prescribing

Project description

Bakgrund

Management av patients with acute sore throat is further complicated by the fact that many asymptomatic carriers of group A streptococci (GAS) actually suffer from viral pharyngitis. Throat swabs cannot differentiate between GAS-induced pharyngitis and GAS carriers with viral pharyngitis, contributing to unnecessary antibiotic prescriptions. Despite guidelines aimed at reducing overprescription, research shows that many physicians fail to follow them. It also remains unclear whether nurses and pharmacists could help reduce antibiotic prescriptions in cases of simpler infections.

Objective

The thesis aims to improve the management of pharyngotonsillitis in primary care, ensuring optimal use of antibiotics for sore throat.

The sub-studies have the following objectives:

1. To investigate the agreement in Centor criteria assessments between digital encounters and in-person consultations.
   
   
2. To estimate the likelihood that GAS findings reflect the actual cause of throat symptoms in patients seeking primary care for sore throat when considering climate zone and patient’s age.
   
   
3. To examine differences in patient characteristics and symptom severity between those seeking care at primary care centers versus pharmacies.
   
   
4. To evaluate whether adherence to guidelines for uncomplicated throat infections differs depending on whether the initial assessment is performed by doctors, nurses, or pharmacists with specific training in throat infections.

Methods

The first sub-study compares Centor criteria assessments between digital consultations and in-person visits through inter-rater agreement analysis.

The second sub-study is a systematic literature review with a meta-analysis of case-control studies to estimate the etiological relationship between sore throat and GAS findings. Both positive and negative etiological predictive values (P-EPV and N-EPV) will be calculated. Positive EPV refers to the likelihood that GAS findings are related to the throat symptoms. Negative EPV indicates the likelihood that symptoms are not associated with GAS in the case of a negative test. Both calculations account for the presence of asymptomatic GAS carriers. The third and fourth sub-studies are part of a broader randomized study in which patients with sore throat are assessed by either physicians, nurses, or pharmacists with specific training in throat infections. The study examines both patient pathways (sub-study 3) and adherence to guidelines (sub-study 4).

Relevance

The thesis is expected to provide insights that improve care for throat infections and reduce unnecessary antibiotic prescriptions. The first sub-study addresses whether Centor criteria can be reliably assessed in digital consultations. The second sub-study provides knowledge that facilitates guideline implementation for strep throat management. Internationally, this study is significant as it sheds light on the debated use of rapid GAS testing for throat infections by calculating P-EPV and N-EPV. The third sub-study will contribute knowledge about patient flows in the management of sore throat, forming a basis for future implementation studies. The fourth sub-study aims to determine whether nurses and pharmacists with specific training can safely manage uncomplicated throat infections and adhere to guidelines as well as or better than physicians. If confirmed, this could reduce the burden on primary care.