The New Guideline “Sore Throat” by the German College of General Practitioners and Family Physicians (DEGAM)

Abstract

Aim: The aim of this guideline is to propose a diagnostic and therapeutic approach to manage sore throat in primary care.

Method: Within the frame of the guideline development program of the German College of General Practice and Family Medicine (DEGAM) the relevant literature on treatment of sore throat in primary care was retrieved and evaluated. During its development, the guideline underwent both a panel-test and a practice-test, and a consensus conference was held with medical societies relevant for sore throat.

Recommendations: Sore throat is generally caused by pharyngitis, as part of a short self-limiting infection of the upper airways. Usually, an accurate etiologic diagnosis is not possible. Suppurative complications like quinsy are rare. The non-suppurative complications acute rheumatic fever and acute poststreptococcal glomerulonephritis have become extremely rare in western industrialized countries. Therefore routine antibiotic treatment of sore throat for the prevention of complications is not recommended in our epidemiological situation. The effect of antibiotics on symptoms and duration of disease is, at best, moderate. It is somehow more pronounced in patients with typical clinical symptoms and signs of pharyngitis by group A streptococci (GAS, S. pyogenes) and even slightly more in case of an additional positive throat swab for GAS. Patients with more severe illness and symptoms and signs of GAS-pharyngitis might be given an antibiotic for symptomatic relief, if assumed effects are considered relevant. An algorithm based on symptoms for decision making is proposed. Rapid testing for streptococcal antigen or a culture for GAS are only recommended if the result is likely to influence therapeutic decisions. All patients should receive information about the prognosis and be advised about analgesic drugs and home remedies.

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(State: 18.10.2010)