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December 26, 1986, Vol 256, No. 24 >
ARTICLE | December 26, 1986

The Management of Sore Throat: Adjusting to Success FREE

Peter E. Dans, MD
JAMA. 1986;256(24):3392-3393. doi:10.1001/jama.1986.03380240086036
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References

The remarkable change in the natural history of group A β-hemolytic streptococcal (GABHS) pharyngitis and its sequelae is one of the great success stories of the 20th century.1,2 Some physicians are now more willing to withhold cultures or defer treatment in patients with sore throat.3,4 Others still prefer immediate treatment because it alters the course of GABHS pharyngitis,5,6 even though in up to 50% or more of patients they treat, GABHS is not isolated. Whether to stop treatment, if cultures are negative, is also controversial depending on the weight assigned to the possibility of false-negative cultures as well as the risks and benefits of continued treatment.7 Thus, the management of sore throat, which appears so simple on its face, clearly illustrates Osler's dictum that medicine is a science of uncertainty and an art of probability.8

To help physicians better manage under uncertainty, a number of

REFERENCES

1 +
Denny FW, Wannamaker LW, Brink WR, et al:  Prevention of rheumatic fever: Treatment of the preceding streptococcic infection . JAMA 1985;; 254:534-537.
2 +
Bisno AL:  The rise and fall of rheumatic fever . JAMA 1985;;254:538-541.
3 +
Cochi S, Fraser DW, Hightower AW, et al:  Diagnosis and treatment of streptococcal pharyngitis: Survey of US medical practitioners , in Management of Pharyngitis in an Era of Declining Rheumatic Fever: Report of the Eighty-Sixth Ross Conference on Pediatric Research . Columbus, Ohio, Ross Laboratories, 1984;, pp 51-59.
4 +
Fulginiti VA:  Still more on streptococcal pharyngitis: An important disease with yet unresolved clinical issues . JAMA 1985;;253:1302.
5 +
Bass JW:  Treatment of streptococcal pharyngitis revisited . JAMA 1986;; 256:740-743.
6 +
Krober MS, Bass JW, Michels GN:  Streptococcal pharyngitis: Placebocontrolled double-blind evaluation of clinical response to penicillin therapy . JAMA 1985;;253:1271-1274.
7 +
Soman M, Fulginiti VA:  Diagnosis and treatment of streptococcal pharyngitis . JAMA 1985;;254:907.
8 +
Osier W, Bean RB, Bean WB: Aphorisms From His Bedside Teachings and Writings . Springfield, Ill, Charles C Thomas Publishers, 1961;.
9 +
Tompkins RK, Burnes DC, Cable WE:  An analysis of the cost-effectiveness of pharyngitis management and acute rheumatic fever prevention . Ann Intern Med 1977;;86:481-492.
10 +
Cebul RD, Poses RM:  The comparative cost-effectiveness of statistical decision rules and experienced physicians in pharyngitis management . JAMA 1986;;256:3353-3357.
11 +
Poses RM, Cebul RD, Collins M, et al:  The importance of disease prevalence in transporting clinical prediction rules . Ann Intern Med 1986;; 105:586-591.
12 +
Komaroff AL, Pass TM, Aronson MD, et al:  The prediction of streptococcal pharyngitis in adults . J Gen Intern Med 1986;;1:1-7.
13 +
Breese BB, Disney FA:  The accuracy of diagnosis of beta streptococcal infections on clinical grounds . J Pediatr 1954;;44:670-673.
14 +
Breese BB:  A simple scorecard for the tentative diagnosis of streptococcal pharyngitis . AJDC 1977;;131:514-517.
15 +
Walsh BT, Brookheim WW, Johnson RC, et al:  Recognition of streptococcal pharyngitis in adults . Arch Intern Med 1975;;135:1493-1497.
16 +
Kellogg JA, Manzella JP:  Detection of group A streptococci in the laboratory or physician's office . JAMA 1986;;255:2638-2642.
17 +
Centor RM, Dalton HP, Campbell MS, et al:  Rapid diagnosis of streptococcal pharyngitis in adult emergency room patients . J Gen Intern Med 1986;;1:248-251.
18 +
Sackett DL, Haynes RB, Tugwell P: Clinical Epidemiology: A Basic Science for Clinical Medicine . Boston, Little Brown & Co Inc, 1985;.
19 +
McDonald CJ, Tierney WM, Hui SL, et al:  A controlled trial of erythromycin in adults with nonstreptococcal pharyngitis . J Infect Dis 1985;;152:1093-1094.
20 +
Poses RM, Cebul RD, Collins M, et al:  The accuracy of experienced physicians' probability estimates for patients with sore throats: Implications for decision making . JAMA 1985;;254:925-929.
21 +
Allman RM, Steinberg EP, Keruly JC, et al:  Physician tolerance for uncertainty: Use of liver-spleen scans to detect metastases . JAMA 1985;; 254:246-248.
22 +
Komaroff AL, Aronson MD, Pass TM, et al:  Serologic evidence of chlamydial and mycoplasmal pharyngitis in adults . Science 1983;;222:927-929.
23 +
Petersen KM, Ingelfinger JA, Komaroff AL, et al:  A randomized trial of erythromycin treatment of pharyngitis in adults, abstracted . Clin Res 1986;;34:379A.
24 +
Evans FO Jr, Sydnor JB, Moore WEC, et al:  Sinusitis of the maxillary antrum . N Engl J Med 1975;;293:735-739.
25 +
Nicotra MB, Rivera M, Awe RJ:  Antibiotic therapy of acute exacerbations of chronic bronchitis . Ann Intern Med 1982;;97:18-21.
26 +
Dans PE:  The great zebra hunt: A view of internal medicine from the walk-in clinic . Pharos 1978;;41:2-6.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Denny FW, Wannamaker LW, Brink WR, et al:  Prevention of rheumatic fever: Treatment of the preceding streptococcic infection . JAMA 1985;; 254:534-537.
2 +
Bisno AL:  The rise and fall of rheumatic fever . JAMA 1985;;254:538-541.
3 +
Cochi S, Fraser DW, Hightower AW, et al:  Diagnosis and treatment of streptococcal pharyngitis: Survey of US medical practitioners , in Management of Pharyngitis in an Era of Declining Rheumatic Fever: Report of the Eighty-Sixth Ross Conference on Pediatric Research . Columbus, Ohio, Ross Laboratories, 1984;, pp 51-59.
4 +
Fulginiti VA:  Still more on streptococcal pharyngitis: An important disease with yet unresolved clinical issues . JAMA 1985;;253:1302.
5 +
Bass JW:  Treatment of streptococcal pharyngitis revisited . JAMA 1986;; 256:740-743.
6 +
Krober MS, Bass JW, Michels GN:  Streptococcal pharyngitis: Placebocontrolled double-blind evaluation of clinical response to penicillin therapy . JAMA 1985;;253:1271-1274.
7 +
Soman M, Fulginiti VA:  Diagnosis and treatment of streptococcal pharyngitis . JAMA 1985;;254:907.
8 +
Osier W, Bean RB, Bean WB: Aphorisms From His Bedside Teachings and Writings . Springfield, Ill, Charles C Thomas Publishers, 1961;.
9 +
Tompkins RK, Burnes DC, Cable WE:  An analysis of the cost-effectiveness of pharyngitis management and acute rheumatic fever prevention . Ann Intern Med 1977;;86:481-492.
10 +
Cebul RD, Poses RM:  The comparative cost-effectiveness of statistical decision rules and experienced physicians in pharyngitis management . JAMA 1986;;256:3353-3357.
11 +
Poses RM, Cebul RD, Collins M, et al:  The importance of disease prevalence in transporting clinical prediction rules . Ann Intern Med 1986;; 105:586-591.
12 +
Komaroff AL, Pass TM, Aronson MD, et al:  The prediction of streptococcal pharyngitis in adults . J Gen Intern Med 1986;;1:1-7.
13 +
Breese BB, Disney FA:  The accuracy of diagnosis of beta streptococcal infections on clinical grounds . J Pediatr 1954;;44:670-673.
14 +
Breese BB:  A simple scorecard for the tentative diagnosis of streptococcal pharyngitis . AJDC 1977;;131:514-517.
15 +
Walsh BT, Brookheim WW, Johnson RC, et al:  Recognition of streptococcal pharyngitis in adults . Arch Intern Med 1975;;135:1493-1497.
16 +
Kellogg JA, Manzella JP:  Detection of group A streptococci in the laboratory or physician's office . JAMA 1986;;255:2638-2642.
17 +
Centor RM, Dalton HP, Campbell MS, et al:  Rapid diagnosis of streptococcal pharyngitis in adult emergency room patients . J Gen Intern Med 1986;;1:248-251.
18 +
Sackett DL, Haynes RB, Tugwell P: Clinical Epidemiology: A Basic Science for Clinical Medicine . Boston, Little Brown & Co Inc, 1985;.
19 +
McDonald CJ, Tierney WM, Hui SL, et al:  A controlled trial of erythromycin in adults with nonstreptococcal pharyngitis . J Infect Dis 1985;;152:1093-1094.
20 +
Poses RM, Cebul RD, Collins M, et al:  The accuracy of experienced physicians' probability estimates for patients with sore throats: Implications for decision making . JAMA 1985;;254:925-929.
21 +
Allman RM, Steinberg EP, Keruly JC, et al:  Physician tolerance for uncertainty: Use of liver-spleen scans to detect metastases . JAMA 1985;; 254:246-248.
22 +
Komaroff AL, Aronson MD, Pass TM, et al:  Serologic evidence of chlamydial and mycoplasmal pharyngitis in adults . Science 1983;;222:927-929.
23 +
Petersen KM, Ingelfinger JA, Komaroff AL, et al:  A randomized trial of erythromycin treatment of pharyngitis in adults, abstracted . Clin Res 1986;;34:379A.
24 +
Evans FO Jr, Sydnor JB, Moore WEC, et al:  Sinusitis of the maxillary antrum . N Engl J Med 1975;;293:735-739.
25 +
Nicotra MB, Rivera M, Awe RJ:  Antibiotic therapy of acute exacerbations of chronic bronchitis . Ann Intern Med 1982;;97:18-21.
26 +
Dans PE:  The great zebra hunt: A view of internal medicine from the walk-in clinic . Pharos 1978;;41:2-6.

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