Efficacy and safety of rapid tests to guide antibiotic prescriptions for sore throat

Cohen, Jérémie F.; Pauchard, Jean-Yves; Hjelm, N M; Cohen, Robert; Chalumeau, Martin

doi:10.1002/14651858.cd012431.pub2

Cited by 25 publications

(23 citation statements)

References 67 publications

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“…Randomized controlled trials have found that Strep A and CRP POC testing reduce antibiotic prescribing at the index consultation. 4,23,26,27,33 However, pragmatic studies on the use of POC testing in general practice show smaller, often statistically non-significant effects. 34 The routine care data we captured pointed towards a different effect of CRP and Strep A testing.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…[16][17][18][19][20] Additional influences include health care system and cultural factors. 3,21,22 POC testing for RTI management has been introduced in primary care thus far mainly to identify a Streptococcal A throat infection, 23 and to use the biomarker C-reactive protein (CRP) to inform antibiotic prescribing for acute cough. 24,25 These POC tests have been shown to decrease antibiotic prescribing for patients with sore throat and acute cough in clinical trials.…”

Section: Introductionmentioning

confidence: 99%

“…24,25 These POC tests have been shown to decrease antibiotic prescribing for patients with sore throat and acute cough in clinical trials. 23,26,27 Uptake of POC testing into national guidelines and clinical practice varies, but the extent to which this explains between-country differences in antibiotic prescribing is unknown.…”

Section: Introductionmentioning

confidence: 99%

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Point-of-care testing, antibiotic prescribing, and prescribing confidence for respiratory tract infections in primary care: a prospective audit in 18 European countries

et al. 2021

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BackgroundBetween-country differences have been described in antibiotic prescribing for RTI in primary care, but not yet for diagnostic testing procedures and prescribing confidence.AimTo describe between-country differences in RTI management, particularly diagnostic testing and antibiotic prescribing, and investigate which factors relate to antibiotic prescribing and GPs’ prescribing confidence.Design & settingProspective audit in 18 European countries.MethodGPs registered patient-, clinical- and management characteristics, and confidence in their antibiotic prescribing decision for patients presenting with sore throat and/or lower RTI (n=4,982). Factors related to antibiotic prescribing and confidence were analysed using multi-level logistic regression.ResultsAntibiotic prescribing proportions varied considerably:<20% in four countries, and >40% in six countries. There was also considerable variation in POC testing (0% in Croatia, Moldova, Romania, and >65% in Denmark, Norway, mainly CRP and Strep A), and in lab/hospital-based testing (<3% in Hungary, Netherlands, Spain, and >30% in Croatia, Georgia, Greece, Moldova, mainly chest X-ray and white blood cell counting). Antibiotic prescribing was related to illness severity, comorbidity, age, fever and ‘country’, but not to having performed a POC test. In nearly 90% of consultations, GPs were confident in their antibiotic prescribing decision.ConclusionDespite high confidence in decisions about antibiotic prescribing, there is considerable variation in the primary care of RTI in European countries, with GPs prescribing antibiotics overall more often than is considered appropriate. POC testing may enhance the quality of antibiotic prescribing decisions if it can safely reverse decisions confidently made on clinical grounds alone to prescribe antibiotics.

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Section: Comparison With Existing Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Point-of-care testing, antibiotic prescribing, and prescribing confidence for respiratory tract infections in primary care: a prospective audit in 18 European countries

et al. 2021

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“…In the case of rural children, who had significantly lower rates of URTIs (p < 0.001) and higher rates of antibiotic therapy relative to the number of infections (p < 0.01), the limited availability of medical consultations played an important role: they tend to consult a doctor at a later stage of disease, when the need for antibiotics is more justified and more likely. Additionally, a lack of quick access to diagnostic tests, the event of clinical doubts, affects the decision to initiate antibiotic treatment by the consulting physician, especially when the next follow-up visit is likely to be in the relatively distant future (32)(33)(34). Undoubtedly, parental knowledge was an important predictor of the decisions made on the use of antibiotics in children with URTIs.…”

Section: Discussionmentioning

confidence: 99%

Impact of Selected Behavioral and Environmental Factors on the Antibiotic Therapy in Polish Children With Upper Respiratory Tract Infections

Dembiński

Konefał³

et al. 2021

Front. Pediatr.

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Antibiotic therapy must be carried out consistently and according to the guidelines. Viruses are the dominant cause of upper respiratory tract infections (URTIs) in children, as has been shown in many previous studies. Unnecessary antibiotic therapy should be avoided so that it does not affect patients' health and lead to the development of resistant bacterial strains. Here we report a national survey conducted in a group of 4,389 children to assess the impact of selected behavioral and environmental factors on antibiotic therapy in patients with URTIs. We found that selected environmental factors influenced the type of treatment. The place of residence, having siblings, an absence of vaccinations, the presence of allergies, and attendance at educational institutions were conducive to antibiotic therapy. These factors also influenced the frequency of hospitalization of children and their absence from nurseries, kindergartens, and schools, as well as the absence of their guardians from work.

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“…An investigation of pediatrician behavior reported that antibiotic prescription rates for children fell by forty-two percentage points after doctors were given the results of RADTs (Kose et al, 2016). These results have been confirmed in randomized control trials of RADTs, which conclude that physicians who use RADTs prescribe antibiotics at lower rates than physicians who do not (Worrall et al, 2007;Llor et al, 2011;Cohen et al, 2020). Modeling techniques that compare different diagnostic methods support these findings, determining that empirical treatment is neither the most effective nor the least expensive technique when the percentage of individuals presenting with pharyngitis is less than 70% (Neuner et al, 2003).…”

Section: Clinical Guidelines For Gabhsmentioning

confidence: 97%

Diagnostic Methods, Clinical Guidelines, and Antibiotic Treatment for Group A Streptococcal Pharyngitis: A Narrative Review

Mustafa

Ghaffari

2020

Front. Cell. Infect. Microbiol.

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The most common bacterial cause of pharyngitis is infection by Group A b-hemolytic streptococcus (GABHS), commonly known as strep throat. 5-15% of adults and 15-35% of children in the United States with pharyngitis have a GABHS infection. The symptoms of GABHS overlap with non-GABHS and viral causes of acute pharyngitis, complicating the problem of diagnosis. A careful physical examination and patient history is the starting point for diagnosing GABHS. After a physical examination and patient history is completed, five types of diagnostic methods can be used to ascertain the presence of a GABHS infection: clinical scoring systems, rapid antigen detection tests, throat culture, nucleic acid amplification tests, and machine learning and artificial intelligence. Clinical guidelines developed by professional associations can help medical professionals choose among available techniques to diagnose strep throat. However, guidelines for diagnosing GABHS created by the American and European professional associations vary significantly, and there is substantial evidence that most physicians do not follow any published guidelines. Treatment for GABHS using analgesics, antipyretics, and antibiotics seeks to provide symptom relief, shorten the duration of illness, prevent nonsuppurative and suppurative complications, and decrease the risk of contagion, while minimizing the unnecessary use of antibiotics. There is broad agreement that antibiotics with narrow spectrums of activity are appropriate for treating strep throat. But whether and when patients should be treated with antibiotics for GABHS remains a controversial question. There is no clearly superior management strategy for strep throat, as significant controversy exists regarding the best methods to diagnose GABHS and under what conditions antibiotics should be prescribed.

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Efficacy and safety of rapid tests to guide antibiotic prescriptions for sore throat

Cited by 25 publications

References 67 publications

Point-of-care testing, antibiotic prescribing, and prescribing confidence for respiratory tract infections in primary care: a prospective audit in 18 European countries

Point-of-care testing, antibiotic prescribing, and prescribing confidence for respiratory tract infections in primary care: a prospective audit in 18 European countries

Impact of Selected Behavioral and Environmental Factors on the Antibiotic Therapy in Polish Children With Upper Respiratory Tract Infections

Diagnostic Methods, Clinical Guidelines, and Antibiotic Treatment for Group A Streptococcal Pharyngitis: A Narrative Review

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