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In their article, Humair et al¹ recommend the use of the streptococcal test and Centor criteria as valid tests for the diagnosis of pharyngitis in adults. After consulting the Internet guidelines on acute sore throat (see "Additional Information" at the end of this letter), we cannot share their opinion for the following reasons:

1. The Centor criteria (fever 38.5°C, absence of cough, tonsillar exudate, and enlarged cervical glands) are only used in 4 guidelines (3 American and 1 Canadian) and not in most of the European guidelines. This is mainly because in the logistic regression analysis that Centor conducted himself, he found that the prevalence of streptococci when 1, 2, 3, and 4 criteria were present were 6.5%, 15%, 32%, and 56%, respectively. Thus, even when the 4 criteria of Centor are present, the chance of a streptococci infection is nearly the same as a coin toss (56%).²
   
2. There is no . . . [Full Text of this Article]

RELATED ARTICLE

Management of Acute Pharyngitis in Adults: Reliability of Rapid Streptococcal Tests and Clinical Findings
Jean-Paul Humair, Sylvie Antonini Revaz, Patrick Bovier, and Hans Stalder
Arch Intern Med. 2006;166(6):640-644.
ABSTRACT | FULL TEXT