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Primary Care

Penicillin for acute sore throat in children: randomised, double blind trial

BMJ 2003; 327 doi: (Published 04 December 2003) Cite this as: BMJ 2003;327:1324

The Centor criteria are not for children

The Centor criteria were derived form an adult population. They
withstood the test of time and have been validated in adults in a number
of studies; however, they were not intended to predict streptococcal
pharyngitis in children. Two of the Centor criteria, fever (temperature
>38 C) and exudate were not found to be significantly associated with
streptococcal pharyngitis in children 1-3. The use of the Centor criteria
as inclusion criterion in this study could have introduced selection bias.
Why did not the authors use a pediatric prediction model?

Another question for the authors, on what physiologic bases can they
explain these findings in comparison to their findings in adults? Why
adults would recover from streptococcal pharyngitis faster if they take
penicillin but not children? Could that simply be because adults complain

1. Meland E, Digranes A, Skjaerven R. Assessment of clinical features
predicting streptococcal pharyngitis. Scand J Infect Dis 1993;25:177-183.

2. Edmond MK, Grimwood K, Carlin JB, Chondros P, Hogg GG, Barnett PL.
Streptococcal pharyngitis in a pediatric emergency department. Med J Aust.

3. Attia M, Zaoutis T, Eppes S, Klein J and Meier F. Multivariate
predictive models for group A beta-hemolytic streptococcal pharyngitis in
children. Acad Emerg Med. 1999;6:8-13.

Competing interests:
Published one of the references cited in the response.

Competing interests: No competing interests

11 December 2003
Magdy W. Attia
Associate Professor of Pediatrics
Alfred I. duPont Hospital of Children