[Initiating a diagnostic and therapeutic measure in a person with signs and symptoms of pharyngitis/tonsillitis]
Rousseau MP
Record ID 32018014520
French
Original Title:
Initier une mesure diagnostique et thérapeutique chez une personne qui présente des signes et symptômes d’une pharyngite-amygdalite
Authors' objectives:
Pharyngitis/tonsillitis, viral or bacterial, is a frequent reason for consultations in primary
care in Québec. Services for detecting Group A streptococci (GAS), the main pathogens
responsible for bacterial pharyngitis/tonsillitis, are available to the population at some
local points of service and at certain pharmacies in the province. The aim of developing a
national medical protocol (NMP) and related collective prescription (CP) template is to
promote a uniform practice across the province and to provide front-line professionals
with the necessary tools for managing GAS pharyngitis/tonsillitis.
Authors' results and conclusions:
RESULTS (#1 DISTINGUISHING GAS PHARYNGITIS/TONSILLITIS): GAS pharyngitis/tonsillitis usually manifests with at least one of the following: tenderness
or swelling of the anterior cervical lymph nodes, tonsillar exudate or swelling and fever
above 38 °C. However, the presence of these symptoms is not specific to SGA infection,
and a viral infection is quite likely. Consequently, the modified Centor score calculation is
recommended for identifying, among those people with such symptoms, those who are
more likely to have a bacterial GAS infection. (#2 TREATING CONFIRMED GAS INFECTION): Penicillin V is the treatment of first choice for GAS pharyngitis/tonsillitis in children and
adults. However, amoxicillin may be considered an alternative, especially when the
person is unable to swallow penicillin V tablets. However, a history of allergies to the
class of β-lactam antibiotics is often reported, but since many of these cases are not true
allergies, any drug allergy reported should be assessed and documented before
considering administering an alternative to penicillin or amoxicillin. CONCLUSION: Publishing this NMP for the management of GAS pharyngitis/tonsillitis should therefore
help promote prompt, appropriate management of this type of infection and standardize
the practice of the different facilities and health professionals. However, upgrading and
harmonizing the practice will depend mainly on the dissemination of the NMP and related
CP template, and on adherence to the changes and the uptake of the recommendations
by the health professionals concerned.
Authors' methods:
The NMP and related CP were drafted in connection with an existing Institut national
d’excellence en santé et en services sociaux (INESSS) publication on
pharyngitis/tonsillitis that was updated in 2017. The recommendations in the NMP are
therefore based on this report, as well as on a brief review of recent recommendations
from learned societies in North America and on consultations with stakeholders in the
relevant areas of expertise, namely, microbiology, infectious diseases, pediatrics, family
medicine, nursing and pharmacy.
Authors' identified further research:
The advisability of updating the NMP and related CP template will be determined during
the next update of INESSS’s optimal use guide on GAS pharyngitis-tonsillitis in children
and adults and on the basis of the health and social services system’s needs.
Details
Project Status:
Completed
URL for protocol:
https://www.inesss.qc.ca/fileadmin/doc/INESSS/Ordonnances_collectives/Pharyngite-amygdalite/Symptomes_pharyngite_amygdalite_PMN_INESSS.pdf
Year Published:
2025
URL for published report:
https://www.inesss.qc.ca/fileadmin/doc/INESSS/Ordonnances_collectives/Pharyngite-amygdalite/Symptomes_pharyngite_amygdalite_GN_INESSS.pdf
English language abstract:
An English language summary is available
Publication Type:
Other
Country:
Canada
Province:
Quebec
MeSH Terms
- Pharyngitis
- Tonsillitis
- Scarlet Fever
- Disease Management
- Antimicrobial Stewardship
- Streptococcal Infections
- Anti-Bacterial Agents
- Diagnostic Tests, Routine
Contact
Organisation Name:
Institut national d'excellence en sante et en services sociaux
Contact Address:
L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name:
demande@inesss.qc.ca
Contact Email:
demande@inesss.qc.ca
Copyright:
L'Institut national d'excellence en sante et en services sociaux (INESSS)
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