Dossier n. 153/2007 [Abstract] Sore throat in children. Regional guidelines

The regional ProBA project (Progetto Bambini e Antibiotici - Project on Children and Antibiotics) started in 2003 in Emilia-Romagna aiming to assess the determinants of antibiotic prescriptions in children and to promote appropriate use of antibiotic for upper respiratory infections. A regional working group was created to develop evidence based guidelines for streptococcal pharyngitis management in children. During the first phase of the ProBA project, based on interviews with parents and paediatricians, the following priorities for action were identified:

• to improve and to facilitate communications between parents and paediatricians, through informative materials developed ad hoc, using a simple language, explaining acute respiratory infections in children (causes, prevention and management) and the correct use of antibiotics;
• to improve paediatricians’ knowledge and skills in the management of sore throat and acute otitis media in children through the development and implementation of evidence based guidelines and through the identification and diffusion of specific instruments to aid the implementation process (decision aids, rapid diagnostic tests, audit and feedback of antimicrobial usage, training courses).

The working group adopted a modified version of the international GRADE system. The grading scheme classifies recommendations as strong or weak according to the quality of evidence, the clinical importance of the outcome considered, the balance among benefits, risks and costs, and the feasibility of the recommendation. The reasons that determined the attribution of the grade to every single recommendation are reported along. This procedure ensures that the attribution process of the grade is transparent and clear.

In the first part of the guideline a summary of the recommendations - dealing with pharyngitis prevention, diagnosis (based on McIsaac clinical score and rapid antigen detection tests), treatment, management of S. pyogenes carrier, referral to hospital and communication to parents - is available for prompt consultation. A diagnostic and therapeutic algorithm developed by the workgroup is presented with other instruments for the guideline implementation.