Assessment of awareness regarding the diagnosis and management of pharyngitis in children among general practitioners




group A β-hemolytic streptococcus, pharyngitis, diagnosis, management


Sore throat and pharyngitis account for up to 5.0% of all medical visits to a general practitioner. The etiology of pharyngitis in both adults and children is dominated by viruses, but in 20.0-30.0% of children the cause may be bacteria, most often the Group A β-hemolytic streptococcus.

Purpose - to assess the knowledge of general practitioners regarding the diagnosis and management of pharyngitis in children, to determine further ways to increase their level of awareness.

Materials and methods. A survey of 60 general practitioners in the Ternopil region of Ukraine was conducted to determine their awareness of the diagnosis and management of pharyngitis in children. The questionnaire and statistical methods were used.

Results. In total, 45.0% of general practitioners in individual cases prescribed bacteriological cultures from the oropharynx to patients with acute pharyngitis. However, they rarely (6.7%) used the Center or McIsaac criteria to choose a treatment strategy for acute pharyngitis. Antibiotic therapy for the treatment of pharyngitis was used in individual cases by 86.7% of respondents. Amoxicillin was chosen as a first-line antibiotic by 38.3% of respondents, while protected aminopenicillins were chosen by 36.6%. Only 10.0% of general practitioners indicated a 10-day course of antibiotic therapy. A little more than half of the correct answers were to questions related to the appointment of antibacterial therapy to healthy children in whom the Group A β-hemolytic streptococcus was detected during bacteriological examination or an increased level of antistreptolysin-O in the blood.

Conclusions. The results of our study showed a different level of knowledge of general practitioners regarding some aspects of diagnosis and management of pharyngitis in children. Insufficient knowledge was demonstrated regarding the possibilities of diagnosing the streptococcal etiology of pharyngitis, in particular the use of both clinical and laboratory research methods. Despite good knowledge about prescribing antibacterial therapy, poor awareness about the duration of antibacterial therapy and incomplete knowledge about the choice of antibacterial agent are shown. Relatively satisfactory knowledge was demonstrated regarding the strategy of management of streptococcal carriage in healthy children.

The presented data indicate the need to improve the awareness of general practitioners regarding the diagnosis and treatment of pharyngitis, taking into account the modern complications of streptococcal infection.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.


Alcolea-Medina A, Snell LB, Alder C, Charalampous T, Williams TGS, Tan MKI et al. (2023). The ongoing Streptococcus pyogenes (Group A Streptococcus) outbreak in London, United Kingdom, in December 2022: a molecular epidemiology study. Clinical Microbiology Infection. 29 (7): 887-890. URL:; PMid:36925107

Boyarchuk OR, Boytsanyuk SI, Hariyan TV. (2017). Acute rheumatic fever: clinical profile in children in western Ukraine. Journal of Medicine and Life. 10 (2): 122-126. URL: PMID: 28616087. PMCID: PMC5467252.

Boyarchuk OR, Hariyan TV, Kovalchuk TA. (2019). Clinical features of rheumatic heart disease in children and adults in Western Ukraine. Bangladesh Journal of Medical Science. 18 (1): 87-93. URL:

Boyarchuk OR, Mochulska OM, Komorovsky RR. (2021). Diagnosis and management of pharyngitis in children: a survey study in Ukraine. GERMS. 11: 363-371. URL:; PMid:34722358 PMCid:PMC8548041

Boyarchuk OR, Mochulska OM. (2021). Analysis of awareness of practical medicinal doctors on diagnosis and treatment of pharyngitis in children. Modern Pediatrics. Ukraine. 4 (116): 29-35. URL:

Carapetis JR, Steer AC, Mulholland EK, Weber M. (2005). The global burden of group A streptococcal diseases. Lancet Infectious Diseases. 5: 685. URL:; PMid:16253886

Coffey PM, Ralph AP, Krause VL. (2018). The role of social determinants of health in the risk and prevention of group A streptococcal infection, acute rheumatic fever and rheumatic heart disease: A systematic review. PLOS Neglected Tropical Diseases. 12 (6): e0006577. URL:; PMid:29897915 PMCid:PMC6016946

Cohen R. (2004). Defining the optimum treatment regimen for azithromycin in acute tonsillopharyngitis. Pediatric Infectious Disease. 23: 129-134. URL:; PMid:14770076

Di Muzio I, d'Angelo DM, Di Battista C, Lapergola G, Zenobi I, Marzetti V et al. (2020). Pediatrician's approach to diagnosis and management of group A streptococcal pharyngitis. European Journal of Clinical Microbiology & Infectious Diseases. 39 (6): 1103-1107. URL:; PMid:31984431

Fyfe C, Grossman TH, Kerstein K, Sutcliffe J. (2016). Resistance to Macrolide Antibiotics in Public Health Pathogens. Cold Spring Harbor Perspectives in Medicine. 6 (10): a025395. URL:; PMid:27527699 PMCid:PMC5046686

Gerber MA, Baltimore RS, Eaton CB. (2009). Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 119 (11): 1541-1551. URL:; PMid:19246689

GOV.UK. (2023). Group A streptococcal infections: report on seasonal activity in England, 2022 to 2023. (2022). 11. URL:

Gunnarsson R, Ebell MH, Wächtler H et al. (2020). Association between guidelines and medical practitioners' perception of best management for patients attending with an apparently uncomplicated acute sore throat: a cross-sectional survey in five countries. BMJ Open. 10 (9): e037884. URL:; PMid:32948565 PMCid:PMC7500311

Hayes СS, Williamson H. (2001). Management of Group A Beta-Hemolytic Streptococcal Pharyngitis. American Family Physician. 63 (8): 1557-1565. URL:

Hedin K, Strandberg EL, Gröndal H, Brorsson A, Thulesius H, André M. (2014). Management of patients with sore throats in relation to guidelines: an interview study in Sweden. Scandinavian Journal of Primary Health Care. 32 (4): 193-199. URL:; PMid:25363143 PMCid:PMC4278394

Little P, Hobbs FD, Moore M et al. (2013). Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management). BMJ Open. 347: f5806. URL:; PMid:24114306 PMCid:PMC3805475

Llor C, Vilaseca I, Lehrer-Coriat E, Boleda X, Cañada JL, Moragas A, Cots JM. (2017). Survey of Spanish general practitioners' attitudes toward management of sore throat: an internet-based questionnaire study. BMC Fam Pract. 18 (1): 21. URL:; PMid:28193184 PMCid:PMC5307696

Michael R, Wessels MD. (2011). Streptococcal pharyngitis. New England Journal of Medicine. 364: 648-655. URL:; PMid:21323542

Mochulska OM, Boyarchuk OR. (2021). Antibiotics prescribed by general practitioners to treat sore throat in children. Pharmacology OnLine. 3: 639-644. URL:

Robertson KA, Volmink JA, Mayosi BM. (2005). Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis. BMC Cardiovascular Disorders. 5: 11. URL:; PMid:15927077 PMCid:PMC1164408

Shaikh N, Leonard E, Martin JM. (2010). Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics. 126 (3): e557-564.; PMid:20696723

Steer AC, Danchin MN, Carapetis JR. (2007). Group A streptococcal infections in children. J Paediatrics & Child Health. 43 (4): 203-213. URL:; PMid:17444820

Sykes EA, Wu V, Beyea MM, Simpson MTW, Beyea JA. (2020). Pharyngitis: Approach to diagnosis and treatment. Canadian Family Physician. 66 (4): 251-257. PMID: 32273409 PMCID: PMC7145142. URL:

Taddio A, Pillon R, Pastore S, Monasta L, Tommasini A, Di Batticta C et al. (2020). Acute rheumatic fever prophylaxis in high-income countries: clinical observations from an Italian multicentre, retrospective study. Clinical and Experimental Rheumatology. 38 (5): 1016-1020. URL: PMID: 31969217.

Tran J, Danchin M, C Steer A, Pirotta M. (2018). Management of sore throat in primary care. Australian journal of general practice. 47 (7): 485-489. URL:; PMid:30114874





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