7.1 Key points for audit

7.1.1 Management of Acute Sore Throat

• Antibiotic prescription rate for sore throat in general practice.
• Number of patient visits to the general practitioner for sore throat symptoms.

7.1.2 Referral criteria for surgery

• Criteria for referral to hospital from general practice.
• Operation rate with reference to the referral criteria.

7.1.3 Admission rates for suppurative complications of sore throat

• Rates of hospital admission for sore throat complication, such as peritonsillitis, quinsy, and parapharyngeal abscess.

7.2 Research priorities

7.2.1 Management of Acute Sore Throat

The guideline development group recommend that randomised trials should be considered in both adults and in children to assess the efficacy, including dosage and duration, of antibiotic therapy with penicillin versus placebo. These trials would have to be carried out in the primary care setting and the main outcomes would be duration and severity of symptoms including pain, fever, inability to eat and inability to carry out usual activities. Further trials of alternative antibiotics could then validly be compared with the effectiveness of penicillin.

7.2.2 Epidemiology of Recurrent Sore Throats

A longitudinal cohort study is required both in adults and in children of the natural history of recurrent episodes of sore throat. The size of the cohorts should be sufficient to allow preparation of a multifactorial analysis of those factors which might predict resolution/non-resolution. This is likely to include age, sex, number of siblings/adults in the home, degree of contact with peers (school, university, etc.), various indications of deprivation including socio-economic group, and exposure to cigarette smoke.

7.2.3 Effectiveness of Surgery For Recurrent Tonsillitis

Randomised controlled trials are required of surgical versus non surgical management with disease specific outcomes, general health outcomes, and costings. Such trials should be sufficiently powered to assess benefit depending on frequency and severity of symptoms prior to operation.

7.2.4 Prescribing Habits of General Practitioners

Studies are required of the prescribing behaviour of general practitioners for sore throat symptoms in relation to workload, time constraints, and socio-economic factors.