Abstract
BACKGROUND: Sore throats may be due to either viral or group A beta hemolytic streptococcus (GABHS) infections; but diagnosis of the etiology of a sore throat is difficult, often leading to unnecessary antibiotic prescriptions and consequent increases in bacterial resistance. Scoring symptoms using the Mclsaac clinical decision rule can help physicians to diagnose and manage streptococcal infections leading to sore throat and have been recommended by the Ministry of Health, Malaysia. In this paper, we offer the first assessment of the effectiveness of the Mclsaac rule in a clinical setting in Malaysia.
METHOD: This study is a retrospective review of 116 pediatric patients presenting with sore throat. Group A comprised patients before the implementation of the Mclsaac rule and Group B comprised patients after the implementation.
RESULTS: Unnecessary throat swab cultures were reduced by 40% (P = 0.003). Redundant antibiotic prescriptions were reduced by 26.5% (P = 0.003) and the overall use of antibiotics was reduced by 22.1% (P = 0.003). The pediatricians' compliance rate to Mclsaac rule criteria was 45% before implementation Of the Mclsaac rule, but improved to 67.9% (P = 0.0005) after implementation.
DISCUSSION: The Mclsaac rule is an effective tool for the management of sore throat in children in Malaysia.