A critical appraisal of acute sore throat guidelines using the AGREE II instrument: a scoping review.

This article evaluates the quality and content of international clinical practice guidelines for managing uncomplicated acute group A beta-haemolytic streptococcal (GABHS) sore throat using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. Among 15 guidelines published between 2000 and 2019, six were classified as high-quality based on a rigour of development score above 60%, and these generally recommend limiting antibiotic use to patients with severe symptoms or at high risk of complications, reflecting the self-limiting nature of acute GABHS sore throat in high-income countries. The guidelines show significant discrepancies regarding the use of clinical scores, rapid antigen tests, and antibiotic therapy, with many low-quality guidelines advocating broader antibiotic use primarily to prevent acute rheumatic fever (ARF) and local complications, while high-quality guidelines emphasize antibiotic stewardship to reduce resistance. The study highlights the need for guidelines grounded in transparent, adequately assessed evidence and calls for further research to identify patients who would most benefit from antibiotic treatment.