NDLI: Management of Acute Pharyngitis in Adults: Reliability of Rapid Streptococcal Tests and Clinical Findings

Content Provider	JAMA Network
Author	Humair, Jean-Paul Revaz, Sylvie Antonini Bovier, Patrick Stalder, Hans
Copyright Year	2006
Abstract	Background: How to use clinical score, the rapid streptococcal antigen test ( RSAT), and culture results is uncertain for efficient management of acute pharyngitis in adults. Methods: This prospective cohort study included 372 adult patients with pharyngitis treated at a Swiss university-based primary care clinic. In eligible patients with 2 to 4 clinical symptoms and signs (temperature ≥38° C, tonsillar exudate, tender cervical adenopathy, and no cough or rhinitis), we performed an RSAT and obtained a throat culture. We measured sensitivity and specificity of RSAT with culture as a gold standard and compared appropriate antibiotic use with cost per patient appropriately treated for the following 5 strategies: symptomatic treatment, systematic RSAT, selective RSAT, empirical antibiotic treatment, and systematic culture. Results: RSAT had high sensitivity (91%) and specificity (95%) for the diagnosis of streptococcal pharyngitis. Systematic throat culture resulted in the highest antibiotic use, in 38% of patients with streptococcal pharyngitis. Systematic RSAT led to nearly optimal treatment (94%) and antibiotic prescription (37%), with minimal antibiotic overuse (3%) and underuse (3%). Empirical antibiotic treatment in patients with 3 or 4 clinical symptoms or signs resulted in a lower rate of appropriate therapy (59%) but higher rates of antibiotic use (60%), overuse (32%), and underuse (9%). Systematic RSAT was more cost-effective than strategies based on empirical treatment or culture: $15.00, $26.00, and $32.00, respectively, per patient appropriately treated. Conclusions: The RSAT we used is a valid test for diagnosis of pharyngitis in adults. A clinical approach combining this RSAT and clinical findings efficiently reduces inappropriate antibiotic prescription in adult patients with acute pharyngitis. Empirical therapy in patients with 3 or 4 clinical symptoms or signs results in antibiotic overuse.
Ending Page	644
Starting Page	640
Page Count	5
File Format	PDF HTM / HTML
ISSN	00039926
DOI	10.1001/archinte.166.6.640
Issue Number	6
Journal	Archives of Internal Medicine
Volume Number	166
Language	English
Publisher	American Medical Association
Publisher Date	2006-03-27
Access Restriction	Open
Subject Keyword	antibiotics pharyngitis, bacterial, acute rapid streptococcal antigen test pharyngitis throat culture
Content Type	Text
Resource Type	Article
Subject	Internal Medicine

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4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
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