Pharyngitis

Centor Criteria: Antibiotics or Not?

EMKF

 

The Centor score is an appropriate screening method for acute tonsillitis but limited to patients of at least 15 years of age. The Centor score uses 4 signs and symptoms and a scale of 0 to 4 for diagnosis.

  1. history of fever > 38oC,
  2. absence of a cough,
  3. swollen and tender anterior cervical lymph nodes, and
  4. tonsillar exudates or swelling

Both the sensitivity and specificity of this prediction rule are 75%, compared with throat cultures. Antibiotics are advised if the Centor score is 3 or above.

 

Do Patients with Pharyngitis Need to Be Treated with Antibiotics?

EMKF

Acute pharyngitis SHOULD NOT typically be treated with antibiotics. The great majority of cases are viral in origin

  • MYTH#1: Antibiotics reduce symptomology – NO THEY DON’T (Steroids DO)
  • MYTH #2: Antibiotics reduce the rate of suppurative complications – NO THEY DON’T (Little 2013).

Clinical Bottom Line:

We are far more likely to HARM patients with pharyngitis by giving antibiotics than to help them

  • 1 in 10 patients will develop antibiotic associated diarrhea (some of these will be C. diff)
  • Severe allergic reactions occur in 0.24% of patients – This means that out of 10 million patients treated with antibiotics, as many as 24,000 of them will have fatal or near-fatal allergic reactions.

Thus, it’s important to determine if the benefits of antibiotic treatment outweigh the risks.