BMJ  2003;327:1327-1328 (6 December), doi:10.1136/bmj.327.7427.1327

Commentary

More valid criteria may be needed

¹ University of Southampton, Aldermoor Health Centre, Southampton SO16 55T ps13@soton.ac.uk

The first 150 words of the full text of this article appear below.

Zwart et al¹ provide a welcome addition to the efficacy literature since a systematic review reports data from only three double blind studies among children and few from typical primary care settings.² The study shows that—among a selected group of more unwell children (with two of the Centor criteria: absence of cough, history of fever, cervical nodes, and purulent pharynx)—antibiotics do not help symptomatically but may reduce imminent quinsy, impetigo, or scarlet fever.

There are several reasons to support the authors' reluctance to advocate immediate antibiotics, even in this more unwell subgroup. The study was not powered a priori to detect deterioration of illness, hence secondary findings must be treated with some caution. Furthermore antibiotics did not prevent true major complications (such as rheumatic fever, quinsy) but the worsening illness (mainly "imminent quinsy"), and all cases resolved with further antibiotics and without admission. Finally efficacy trials with close follow up . . . [Full text of this article]

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More valid criteria has been published

Magdy W. Attia
bmj.com, 11 Dec 2003 [Full text]

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