Opinions were divided as to whether modified Centor criteria taking into account age under 15 years and over 45 years would be more useful in aiding treatment of a potential Strep throat. In addition, certain other patient groups at increased risk of infection should be considered, such as the immunocompromised, those with HIV, those who have underlying disease or specific local populations, e.g. Aboriginal or Torres Strait Islanders in Australia. Dr Duerden advocated that healthcare professionals should be alert for frail patients, who often have underlying disease.

Using the Centor criteria in conjunction with a Strep test would be of value. New research shows that of those cases confirmed with culture as Group A Streptococcus, physicians correctly identified 27% (11/40) of cases. Physicians correctly believed Group A Streptococcus was unlikely in 32% (133/401) of all cases and a further 18% (74/401) of all cases were diagnosed incorrectly as likely or very likely due to Group A Streptococcus. For 46% (183/401) of cases, physicians were uncertain whether Group A Streptococcus was the cause.⁸ It was recommended that testing should only be undertaken where a positive response would change management, but Dr Pignatari added that, in countries where antibiotic prescribing rates are high, testing can be instrumental in dissuading doctors from prescribing.

Providing guidance on the normal duration of the various respiratory tract infections and offering alerts on worsening and red flag symptoms was also recommended, to ensure concerns around secondary infections could be addressed. Other factors to consider were frequency of infection, criteria for tonsillectomy and current epidemics.