Appropriate Testing for Pharyngitis (CWP)

The percentage of episodes for persons 3 years and older where the person was diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode. 

Why It Matters

Pharyngitis is one of the most common causes of ambulatory health care utilization and can be caused by both bacterial and viral infection. Pharyngitis is the only condition among upper respiratory infections (URI) where diagnosis is validated easily and objectively through administrative and laboratory data, and it can serve as an important indicator of appropriate antibiotic use among all respiratory tract infections (1). While pharyngitis is typically caused by a viral infection, it can also be caused by a bacterial infection of group A streptococcus. To limit unnecessary antibiotic use for pharyngitis caused by viruses, clinical practice guidelines recommend that patients presenting with pharyngitis only receive antibiotics if a group A streptococcal test indicates bacterial infection. 

Overuse of antibiotics has been directly linked to the prevalence of antibiotic resistance; promoting judicious use of antibiotics is important to reducing levels of antibiotic resistance (1). Clinical practice guidelines recommend group A strep should be tested by a rapid antigen detection test and/or throat culture, and that patients who test positive should be treated with an appropriate antibiotic at an appropriate dose (2). Antibiotic overuse and inappropriate use has been observed in children with pharyngitis in the United States (3). 

Organizations have shown effective ways of targeting physicians and members to reduce inappropriate antibiotic prescribing at past HEDIS conferences. Organizations can also work with national and state public health agencies—such as the CDC—to educate and raise awareness with members and physicians on inappropriate antibiotic use. 

A higher rate indicates better performance (i.e., appropriate testing). 

Historical Results – National Averages

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References

  1. Clinical Guidance for Group A Streptococcal Pharyngitis. Centers for Disease Control and Prevention. Updated March 1, 2024. Accessed April 7, 2025. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html
  2. Mustafa, Z. & M. Ghaffari. 2020. “Diagnostic Methods, Clinical Guidelines, and Antibiotic Treatment for Group A Streptococcal Pharyngitis: A Narrative Review.” Front Cell Infect Microbiol 10:563627. doi: 10.3389/fcimb.2020.563627
  3. Shulman, S.T., A.L. Bisno, H.W. Clegg, et al. 2012. “Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America.” Clinical Infectious Diseases 55:e86–102
  4. Dooling, K.L., D.J. Shapiro, C. Van Beneden, et al. 2014. “Overprescribing and Inappropriate Antibiotic Selection for Children with Pharyngitis in the United States, 1997-2010.” JAMA Pediatrics 168:1073–4.

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