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The impact of a sore throat score and a rapid antigen test on clinical management in streptococcal pharyngitis

Abstract number: 1134_01_137

Stingu C.S., Turcu T., Dimitriu S.

Objective:  

To establish the impact of a sore throat score and a rapid antigen test for group A streptococci on clinical management of patients with acute pharyngitis focusing on reducing the antibiotic prescription.

Methods:  

This study included 98 patients hospitalized in Infectious Disease Hospital, Lasi, Romania. From each patient we collected clinical data for the score and two pharyngeal swabs: one for rapid antigen test (One Step Strep A Test Cassette–AccuBioTech- a two side sandwich immunoassay) and the second one for culture. Catalase negative, gram positive cocci in chains were serogrouped using a latex-agglutination kit (Slidex Strepto A – BioMerieux). All patients had no antibiotic therapy prior examination and no other infectious diseases. We compared physicians intent for prescribing antibiotics based on clinical data with physicians practice after doing the score and rapid antigen test. We have to state that the hospital standard procedure for diagnosis of acute pharyngitis doesn't include the score and the rapid antigen test. The patients were hospitalized 5–7 days.

Results:  

Of 98 patients 32 (32.65%) had group A streptococcal pharyngitis, and from 17 (17.34%) patients we isolated non group A beta hemolytic streptococci. Combination of score and rapid test didn't miss any positive result (95%CI: 82.35%–99.87%) and had a good specificity: 93.75% (95%CI: 69.77%–99.84%). Based upon intent the physicians would have prescribed antibiotics for 85 patients including 36 (73.46%) with negative culture and all 17 patients with non group A beta hemolytic streptococci. After doing the score and receiving the results of the rapid antigen test the physicians prescribed antibiotics only for 33 patients (reducing the overall prescription for antibiotics with 67.17%).

Conclusions:  

The score higher than 3 and the rapid antigen test improved the use of antibiotics as follows: 1. All patients with group A streptococcal pharyngitis received the proper course of antibiotics. 2. Only one patient received unnecessary therapy. 3. The combination of score higher than 3 and rapid antigen test reduced the prescription of unnecessary antibiotics with 98.11% on a first visit of a patient with sore throat. 4. The number of hospitalization days would have been reduced from 5–7 to 2 days in 66.33% of cases.

Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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