Background Inappropriate use of antibiotic treatment for pharyngitis by 
community pharmacists is prevalent in developing countries. Little is known 
about how the pharmacists identify patients with bacterial pharyngitis. 
Objective To ascertain the appropriateness of diagnosis of streptococcal 
pharyngitis among Thai community pharmacists according to the Centor criteria 
and to identify factors related to antibiotic dispensing. Setting 1040 Thai 
community pharmacists. Method A cross-sectional survey of community pharmacists 
was conducted in November 2012 to March 2013. The self-administered 
questionnaires were mailed to 57 % of community pharmacists in the south of 
Thailand (n = 1040). The survey included questions on diagnosis of streptococcal 
pharyngitis, knowledge on pharyngitis, and attitudes and control beliefs 
regarding antibiotic dispensing. Main outcome measure The appropriateness of 
diagnosis of streptococcal pharyngitis according to the original and modified 
Centor criteria and determinants of antibiotic dispensing including demographic 
characteristics of pharmacists, knowledge on pharyngitis, and attitudes and 
control beliefs on antibiotic dispensing. Results Approximately 68 % completed 
the questionnaires (n = 703). Compared to the pharmacists who reported not 
dispensing antibiotics in the hypothetical case with common cold, those reported 
dispensing antibiotics were more likely to consider the following 
conditions-presence of cough, mild sore throat and patients with age >60 years 
as cues for diagnosis of streptococcal pharyngitis (p < 0.05). The use of fewer 
scores of the clinical prediction rules for diagnosis was observed in antibiotic 
dispensers, compared to who did not do so (p < 0.005). Antibiotic dispensing was 
positively associated with period of dispensing experience (>5 years) [odds 
ratio (OR) 1.52; 95 % confidence interval (CI) 1.03-2.23], belief that 
antibiotics could shorten duration of pharyngitis (OR 1.48; 95 % CI 1.11-1.99), 
belief that antibiotics could prevent the complications (OR 1.44; 95 % CI 
1.09-1.91) and belief that dispensing antibiotics could satisfy the patients (OR 
1.31; 95 % CI 1.01-1.71). Nonetheless, antibiotic dispensing was negatively 
associated with knowledge about pharyngitis (OR 0.83; 95 % CI 0.75-0.93). 
Conclusion Pharmacists who are knowledgeable on the Centor criteria are more 
likely to appropriately diagnose streptococcal pharyngitis and less likely to 
dispense antibiotics in such case.