In the Centor Criteria, what symptom is given a negative point for patients older than 44?

The Centor Criteria are used to assess the probability of streptococcal pharyngitis in patients with sore throat. In this scoring system, certain clinical findings are assigned positive and negative points based on the patient's age. For patients older than 44, the presence of a lack of cough is given a negative point. This is significant because the criteria aim to stratify the risk of streptococcal infection based on clinical features that correlate with the likelihood of bacterial versus viral infection.

Older adults typically exhibit different presentations of upper respiratory infections than younger individuals, and the lack of cough is often more indicative of viral infections in this age group. By assigning a negative point for the absence of a cough, clinicians can more accurately differentiate between the two types of infections, guiding the decision-making process regarding the necessity for testing and treatment.

In contrast, fever, tonsillar exudates, and lymphadenopathy are traditionally markers that, if present, increase the probability of streptococcal infection and contribute positively to the scoring for younger patients. However, for those over 44, the lack of cough suggests that a viral etiology is more likely, hence the negative weighting in the scoring system.