Impact of Centor scores on determining antibiotic prescribing in children

The purpose of this paper is to establish the effect of incorporating Centor scoring into antibiotic prescribing in primary care in London, UK, before and after the introduction of an educational package and prescribing software tool.

A quality improvement project with analysis of all sore throat presentations in patients aged 3-14 years, in two phases. Phase 1 (retrospective): 1 January-31 December 2013, followed by an intervention (software tool/education package) and Phase 2 (prospective): 1 March 2014-28 February 2015.

In the initial analysis, 162 out of 202 (80.2 per cent) patients were prescribed antibiotics. Following the educational/software intervention, 191 out of 231 (82.7 per cent) patients were prescribed antibiotics (p=0.56, χ² test). The mean Centor score decreased significantly following the education/software intervention (3.1 vs 2.7, p<0.001, χ² test). In all, 100 per cent of patients with tonsillar exudate were prescribed antibiotics in both phases. The apparent order of importance for predictive signs/symptoms given by the prescribers in both phases of the study was tonsillar exudate>lymphadenopathy>fever>absence of cough.

This is the first time a differential importance given by practitioners on individual Centor criteria has been described. With a low probability of bacterial infection, children with exudate or anterior lymphadenopathy almost always received antibiotics. This is interesting, since studies have previously found that the presence of tonsillar exudate had no significant association with culture-confirmed streptococcal tonsillitis.