Managing sore throat: theory versus practice.

The authors address the reliability of clinical impression in the management of sore throat. Five primary care family physicians in rural Ontario examined 222 patients with sore throats. The clinical impression of either Group A β-hemolytic streptococcal (GABHS) or non-GABHS pharyngitis was recorded and throat cultures were ordered in each case. The physicians predicted that 50% of the cultures would be positive for GABHS, whereas only 13.5% actually had positive results. The initial clinical diagnosis of "strep throat" was correct only one in five times. Without cultures, at least 112 patients would have been treated with antibiotics, 87 unnecessarily. The authors conclude that the clinical prediction of GABHS is inaccurate and can lead to unnecessary use of antibiotics.