TY - JOUR T1 - Major global discrepancies in guidelines for sore throat (acute pharyngitis) JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.congress-2020.3273 VL - 56 IS - suppl 64 SP - 3273 AU - Graca Coutinho AU - Martin Duerden AU - Aurelio Sessa AU - Attila Altiner AU - Sergio Caretta-Barradas Y1 - 2020/09/07 UR - http://erj.ersjournals.com/content/56/suppl_64/3273.abstract N2 - While most causes of sore throat are viral, group A streptococci (GAS), which can cause acute rheumatic fever (ARF), are detected in 15‑30%. To check the consistency of diagnostic and treatment criteria for sore throat, we compared guidelines worldwide.A systematic literature search was done in MEDLINE, EMBASE and COCHRANE, and on web sites of the major health authorities and institutions from Africa, Asia, Europe, Middle East, North America, Oceania and South America.We identified 33 guidelines from 25 countries. Their availability varied considerably by region; they were particularly scarce in Africa. Recommendations relied most often on symptom- and age-based Centor or McIsaac scores (or similar). Yet several approaches based antibiotic therapy on other symptomatic criteria; in the most extreme approach just sore throat in children. The recommendation of GAS-specific tests was mainly limited to countries where these are available, although some countries choose not to use them. Penicillins were consistently recommended as first-line antibiotics. An important finding was that guidance for symptomatic treatment was generally sparse or missing.The discrepancies across guidelines regarding diagnostic and treatment criteria may be explained by historical background or adoption of external guidelines, rather than local incidences of GAS infections or ARF. Regions where sore throat guidelines are unavailable (Central Africa), or bypassed because antibiotics can be bought without prescription (Southeast Asia), are afflicted by rising antibiotic resistance. The absence of recommendations on symptomatic treatment, which is the mainstay of effective sore throat management, rather than antibiotics, is concerning.FootnotesCite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 3273.This abstract was presented at the 2020 ERS International Congress, in session “Respiratory viruses in the "pre COVID-19" era”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only). ER -