The symptom of ‘cough’ had the highest sensitivity for streptococcal pharyngitis in this study; however, absence of cough is more valid clinical indicator for the diagnosis of streptococcal pharyngitis in children, and even in modified Centor score one point is being attributed to absence of cough [3,4].

Rhinorrhea is an important symptom for viral upper respiratory tract also infection and authors had also mentioned in methodology that children with such symptoms were excluded from the study. However, fifty children (16 in culture positive and 34 in culture negative group) had rhinorrhea as one of the symptom in this study. A child with current viral infection may have false positive throat culture due to chronic streptococcal colonization [4]. These factors might have been responsible for low positive predictive value for modified Centor score for the diagnosis of streptococcal pharyngitis in this study. It would have been interesting if author could have also investigated for viral etiology in this study.

The authors presented antibiotic sensitive pattern to different antimicrobial agents used in streptococcal pharyngitis, which is very helpful information for clinical practice. However, as Penicillin or first generation cephalosporin is the antimicrobial therapy of choice in streptococcal pharyngitis, it would be informative for general practitioner if author had also provided information about resistance to these antibiotics.

1. Vasudevan J, Mannu A, Ganvi G. McIsaac modification of centor score in diagnosis of streptococcal pharyngitis and antibiotic sensitivity pattern of beta-hemolytic strepto-cocci in Chennai, India. Indian Pediatr. 2019;56;49-52.

2. McIsaac WJ, Kellner JD, Aufricht P, Vanjaka A, Low DE. Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA. 2004;291:1587-95.

3. Lindgren C, Neuman MI, Monuteaux MC, Mandl KD, Fine AM. Patient and parent-reported signs and symptoms for group A streptococcal pharyngitis. Pediatrics. 2016; 138:e20160317.