ASSOCIATION BETWEEN MCISAAC SCORE AND ANTIBIOTIC PRESCRIBING IN SUSPECTED BACTERIAL TONSILLITIS
Main Article Content
Keywords:
Tonsillitis, McIsaac_ScoreMcIsaac_Score, Antibiotic_UseAbstract
Tonsillitis is a common upper respiratory tract infection in children and adolescents. Although most cases are caused by viruses, antibiotics are still frequently prescribed. The McIsaac score is used to estimate the likelihood of group A Streptococcus infection and to support rational antibiotic use, but its application in clinical practice remains variable. This study aimed to analyze the relationship between the McIsaac score and antibiotic use in tonsillitis patients. This analytic observational study with a cross-sectional design used retrospective medical record data from RSUD K.R.M.T. Wongsonegoro Semarang from January 2020 to December 2025, with a sample of 97 patients. Most patients were in the moderate McIsaac score category (83.5%). Antibiotics were prescribed in 48.5% of cases, while 45.7% fell into the moderate category. Fisher–Freeman–Halton test results showed no significant relationship between the McIsaac score and antibiotic use (p=0.314). These findings indicate that antibiotic use has not been fully based on McIsaac score assessment, highlighting the need to strengthen the implementation of antibiotic stewardship in clinical practice.
Article Details
References
1. Wiratama PJ, Yudhanto D, Dirja BT. Sebuah Tinjauan Pustaka : Tonsilitis Kronis. J Medika Hutama. 2023 Jan;4(2):3244–50. https://jurnalmedikahutama.com/index.php/JMH/article/view/599
2. Diza M, Gunawan D, Sirait LFP. Hubungan Tonsilitis Kronis dengan Kejadian Otitis Media Akut pada Anak Usia 1-17 Tahun di Poliklinik THT Rumah Sakit Budi Kemuliaan Tahun 2019 -2021. Zona Kedokteran [Internet]. 2023 May;13(2):365–72. Available from: https://ejurnal.univbatam.ac.id/index.php/zonadokter/article/view/1176.
3. Asabella Prihandini T, Kandhi PW. Hubungan antara Usia dengan Kualitas Hidup Penderita Tonsilitis Kronik. Plexus Medical Journal. 2023 Jan 11;1(6):224–33. doi:10.20961/plexus.v1i6.507
4. Alanazi GH, Alzahrani OA, Alsharif BH, Alsumali EM, Alsbyani KE, Hajaji AS, et al. An Updated Review About Tonsillitis-Overview for Healthcare Professionals [Internet]. Vol. 23. Review of Contemporary Philosophy; 2024. p. 6554–63. Available from: https://reviewofconphil.com
5. Fliafel IK, Obayes MS, Saleem HK. Predominance of Antibiotic-Resistant Bacteria in Recurrent Tonsillitis and the Frequency of Antibiotics: A Clinical Study. Indonesian Journal on Health Science and Medicine. 2025 Jan 17;2(1). doi:10.21070/ijhsm.v2i1.65
6. Kanagasabai A, Evans C, Jones HE, Hay AD, Dawson S, Savović J, et al. Systematic review and meta-analysis of the accuracy of McIsaac and Centor score in patients presenting to secondary care with pharyngitis. Clinical Microbiology and Infection. Elsevier B.V.; 2024. p. 445–52. doi:10.1016/j.cmi.2023.12.025. PubMed PMID: 38182052.
7. Taya U, Abonewair M, Hosni A, Abo-Rahma AH, AbdElrhaman NH. Assessing the Diagnostic Accuracy and Validity of the Mcisaac Modified Centor Score in Predicting Group A Beta Hemolytic Streptococcal Pharyngitis in A Trial to End Antibiotic Abuse in Children. SVU-International Journal of Medical Sciences [Internet]. 2024 Jul 1;7(2):767–77. doi:10.21608/svuijm.2024.284113.1840
8. Arroll B, Allan G, Raina Elley C, Kenealy T, McCormack J, Hudso B, et al. Diagnosis in primary care: probabilistic reasoning. J Prim Health Care. 2012;(4):166–73. doi: 10.1071/HC12166
9. Pecina JL, Nigon LM, Penza KS, Murray MA, Kronebusch BJ, Miller NE, et al. Use of the McIsaac Score to Predict Group A Streptococcal Pharyngitis in Outpatient Nurse Phone Triage and Electronic Visits Compared With In-Person Visits: Retrospective Observational Study (Preprint). J Med Internet Res. 2020 Nov 23. doi:10.2196/preprints.25899
10. Karnita Y, Safarianti, Setiani L, Kurnia B, Hayati Z. Conformance of Mc Isaac Modification of Centor Score with Microorganisms of Tonsil Core Tissue in Chronic Tonsillitis Patients. Proceedings of the 19th Otorhinolaryngology Head and Neck Surgery National Congress (PERHATIKL 2022). 2023. p. 115–21. doi:10.2991/978-94-6463-280-4_21
11. Smith KL, Hughes R, Myrex P. Tonsillitis and Tonsilloliths: Diagnosis and Management. Am Fam Physician [Internet]. 2023;107(1):35–41. Available from: www.aafp.org/afp
12. Abdullah B, Koh KC, Mohamed M, Tan VES, Mohammad N, Sekawi Z, et al. Treatment of Acute Sore Throat in Malaysia: A Consensus of Multidisciplinary Recommendations Using Modified Delphi Methodology. Infect Drug Resist. 2024;17:4149–60. doi:10.2147/IDR.S477038
13. Gunnarsson RK, Ebell M, Centor R, Little P, Verheij T, Lindbæk M, et al. Best management of patients with an acute sore throat–a critical analysis of current evidence and a consensus of experts from different countries and traditions. Infect Dis. 2023;55(6):384–95. doi:10.1080/23744235.2023.2191714 PubMed PMID: 36971650.
14. Bhandari S, Dr P, Gurung K. Correlation between McIssac Score and Throat Swab Culture in Patient Presenting with Acute Tonsillitis. JNGMC. 2021. doi:10.3126/jngmc.v19i2.42994
15. Bukhari H, Madloul M, Alorinan B, Albarrak N, Alotiabi W, Sayed S. Prevalence study of acute tonsillitis among pediatrics age groups. International Journal of Medical Reviews and Case Reports. 2019;(0):1. doi:10.5455/ijmrcr.acute-tonsilitis-pediatrics
16. Wardana SP, Pardoe LDP, Yolanda MR, Yulianti AF, Habib P. Tonsillitis in Focus: Clinical Features, Diagnostic Methods, and Evidence-Based Therapy. Jurnal Biologi Tropis. 2025 Oct 1;25(4):4783–90. doi:10.29303/jbt.v25i4.10090
17. Rachmawati S, Masito DK, Rachmawati E. Evaluasi Penggunaan Antibiotik pada Pasien Anak Rawat Inap di RSD Dr. Soebandi Jember. Jurnal Farmasi Galenika (Galenika Journal of Pharmacy) (e-Journal). 2020 Sep 30;6(2). doi:10.22487/j24428744.2020.v6.i2.14976
18. Leung AKC, Lam JM, Barankin B, Leong KF, Hon KL. Group A β-hemolytic Streptococcal Pharyngitis: An Updated Review. Curr Pediatr Rev [Internet]. 2023 Jul 26;21(1):2–17. doi:10.2174/1573396320666230726145436 PubMed PMID: 37493159.
19. World Health Organization (WHO). The WHO AWaRe (Access, Watch, Reserve ) antibiotic book. In. 2022. Available from: http://apps.who.int/bookorders.
20. Linder JA, Watson ME, Wessels MR, Carter DM, Cohen AL, Dien Bard J, et al. 2025 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Group A Streptococcal (GAS) Pharyngitis: Risk assessment using clinical scoring systems in children and adults. Clinical Infectious Diseases. 2025 Dec 4. doi:10.1093/cid/ciaf668
