Sore Throat—A Diagnostic and Therapeutic Dilemma

THE MANAGEMENT of acute pharyngitis has become, more than ever, a frustrating experience for the practitioner. Without a throat culture, the differentiation between viral and streptococcal pharyngitis is unsatisfactory. On the other hand, a positive throat culture in itself does not necessarily mean that a significant streptococcal infection is in progress. For example, a patient with viral pharyngitis might be carrying group A streptococci which are not actually causing infection. How then is the clinician to make an accurate diagnosis in time to treat streptococcal disease intelligently? The problem is not insurmountable if he makes throat cultures routinely in all patients whom he examines with nasopharyngitis. Value of Throat Cultures.— By making throat cultures in all patients with nasopharyngitis, the physician becomes aware of the epidemiology of the infections he encounters. A throat culture which is negative for β-hemolytic streptococci will exclude the unnecessary and promiscuous use of expensive antibiotics.