Dossier n. 253/2015 [Abstract] Acute pharyngitis in childhood. Regional guideline

This guideline on Acute pharyngitis in childhood updates the guideline published by Emilia-Romagna Region in 2007. Acute pharyngitis is a frequent condition in childhood, causing repeated clinical visits, emergency department visits, and inappropriate antibiotic prescribing.

For the management of pharyngitis, it recommends the use of the McIsaac clinical score associated, in selected patients, with the rapid antigen detection test (RADT) and the prescription of amoxicillin when an antibiotic treatment is needed.

Changes from 2007 guideline mainly refer to the diagnostic algorithm. In 2007 RAD use was extensively recommended and a confirmatory throat swab culture was requested in some instances. In the new algorithm RAD is recommended only for intermediate scores (3 or 4), confirmatory throat swab culture is never requested and for children with McIsaac score equal to 2 neither the test nor the treatment are recommended.

The new algorithm has been simplified to achieve a widely implementation by health professionals working in the Emilia-Romagna region. It confers a similar accuracy to the diagnostic process than the previous one but it is more cost-effective, as it results in the cost-effective analysis reported in Annex 8. The aim of the regional guideline is to improve the attitude toward correct antibiotic prescribing among health professionals, an area where there is room for improvement.

In addition, a simple software to improve case management and to increase compliance to recommendations by health professionals has been developed. The software automatically provides the McIsaac score based on symptoms and signs registered, and suggests the correct clinical decision.

The structure of the guideline is also renewed: a red vertical bar highlights changes from the previous version of the regional guideline and differences from other guidelines on the same topic, a green vertical bar indicates contents of practical interest for health professionals.

To increase the usability of the guideline tools for counselling and prevention are included in the Annexes.

Finally, to make the main document concise and user-friendly, the tables of evidence of selected studies are available only as online material.

The guideline, based on the GRADE methodology, was developed by a multi-professional group of regional experts and was externally revised.