DAVID TELL: Tonsillitis in primary care – Management and evaluation of new treatment strategies

Project description

Background

Antibiotic resistance is one of the most significant threats to global health. The relationship between antibiotic use and the development of resistant bacteria is well-documented. In primary care, which accounts for 65% of all antibiotic prescriptions, respiratory infections represent the majority of cases. Among these, pharyngotonsillitis is the leading cause of antibiotic prescriptions.

While clear guidelines exist for the management of pharyngotonsillitis, they are not always adhered to by clinicians. Antibiotic treatment is beneficial for cases of pharyngotonsillitis with more pronounced symptoms and the presence of group A Streptococci (GAS). However, other bacteria can cause similar symptoms, and there is a lack of studies examining whether antibiotics are effective for pharyngotonsillitis caused by non-GAS pathogens.

Recent research has shown that a short, intensive five-day antibiotic course is as effective as the standard 10-day treatment. However, it remains uncertain whether all patients can be treated effectively with the shorter course or if certain symptoms indicate the need for a longer treatment duration.

Objective

To compare standard antibiotic treatment with a shorter, more intensive regimen in patients with pharyngotonsillitis who present with more pronounced symptoms and confirmed presence of group A Streptococci (GAS), as well as to investigate whether patients with pharyngotonsillitis without GAS benefit from antibiotic therapy.

Additionally, to examine adherence to pharyngotonsillitis management guidelines in primary care and to develop an intervention aimed at improving compliance with these guidelines.

Method

• Part 1: A post-hoc analysis of data from a clinical drug trial involving 433 patients with pronounced pharyngotonsillitis who tested positive for group A Streptococci (GAS). Patients were randomized to receive either a five-day or a ten-day treatment with phenoxymethylpenicillin. The population will be divided into groups based on the severity of symptoms at inclusion and treatment regimen.
  
  
• Part 2: A retrospective medical record review study aimed at evaluating adherence to recommended management of pharyngotonsillitis. Descriptive statistics will be used to report the proportions of physicians (by category) and nurses following the guidelines. Analytical statistics will examine the influence of employment type on adherence to recommendations.
  
  
• Part 3: A randomized, controlled, open-label, prospective multicenter study involving patients with GAS-negative pharyngotonsillitis. Participants will be randomized to either receive antibiotic treatment or no antibiotic treatment.

Relevance

Part 1 provides expanded knowledge about which GAS-positive patients with pharyngotonsillitis benefit the most from antibiotic treatment.

Part 2 offers a deeper understanding of the management of pharyngotonsillitis in primary care and sheds light on potential differences in treatment approaches between various healthcare providers. Based on the results, a targeted intervention study is planned, which will form Part 4.

Part 3 aims to enhance understanding of whether antibiotics reduce symptom duration in GAS-negative patients with pharyngotonsillitis.