Need for a clinical decision rule for the management of pharyngitis in Nigeria

Pharyngitis is a common reason for presentation in the hospital by children. Although viral aetiology is the commonest, Group A Streptococcus is the most important cause of and reason for antibiotic treatment of pharyngitis. The fact that GAS causes the non suppurative sequalae of rheumatic fever and acute glomerulonephritis perhaps drives the empirical antibiotic treatment of most cases of pharyngitis. The unnecessary antibiotic treatment contributes to antibiotic resistance, a major public health problem. While it is desirable to do throat culture to guide the physician’s management of each case, the required laboratory skill is unavailable in most clinical settings in Nigeria. A clinical decision rule (CDR) which is a clinical tool that helps guide physicians in the management of conditions such as pharyngitis, have been shown to be helpful in managing pharyngitis in other countries. It reduces the number of unnecessary antibiotic prescriptions and has a high sensitivity and specificity in distinguishing GAS from non GAS pharyngitis. Currently there are no guidelines or CDR for the management of pharyngitis in Nigeria, there is an urgent need to derive, validate and implement a CDR to guide the treatment of pharyngits.