Table 5. Comparison of major guidelines for acute pharyngotonsillitis caused by Streptococcus pyogenes .
| Category | Present guideline | Antibiotics Guideline for Children with Acute Upper Respiratory Infection-Korea (2016) | IDSA (2012) | American College of Physicians (2001) | American Academy of Pediatrics (2003) | NICE (2008) |
|---|---|---|---|---|---|---|
| Initial diagnosis of acute pharyngo-tonsillitis | Modified Centor score or clinical manifestations of S. pyogenes infection | Modified Centor score or clinical manifestations of S. pyogenes infection | Clinical manifestations and epidemiology suggestive of S. pyogenes infection (example: sudden sore throat, fever, tonsillar exudate/nasal drainage, hoarseness, cough, and oral ulcer suggestive of acute viral pharyngitis) |
Modified Centor score | Modified Centor score | |
| Recom-mendation for diagnostic testing | Three or more modified Centor criteria | Findings suggestive of S. pyogenes or three or more modified Centor criteria | All patients with suspected S. pyogenes infection | Three or more modified Centor criteria | Not recommended | |
| Additional culture if negative on rapid antigen test | Adults: No | Children: Yes | Children: Yes | Children: Yes | Children: Yes | Not recommended |
| Adults: No | Adults: Yes in some communities | Adults: No | ||||
| Indication for antibiotics | 1. Three or more modified Centor criteria | Positive for S. pyogenes on rapid antigen test or culture | Positive for S. pyogenes on rapid antigen test or culture | 1. Empirical antibiotics: four or more modified Centor criteria | Three or more modified Centor criteria | |
| 2. Complication (e.g., otitis media, peritonsillar abscess, acute glomerulo-nephritis, rheumatic fever) | 2. Antibiotics therapy: positive for S. pyogenes on rapid antigen test or culture | |||||
| Anti-biotics | oral amoxicillin | oral amoxicillin | Oral penicillin V, IM benzathine penicillin G. For children, oral amoxicillin is as effective as penicillin and tastes better. | Not specified | ||
| Penicillin allergy | Type 4 (e.g., rash): cephalosporin | Not anaphylaxis: first-generation cephalosporin | Type 4 hypersensitivity: first-generation cephalosporin (e.g., cephalexin) | Not specified | ||
| Type 1 (e.g., anaphylaxis): non-beta-lactams | Anaphylaxis: beta-lactams prohibited, only non-beta-lactams | Type 1 hypersensitivity: clindamycin, clarithromycin, or azithromycin | ||||
IDSA, Infectious Diseases Society of America; NICE, National Institute of Health and Care Excellence.