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Influence of rapid antigen detection test use to antibiotic prescribing for tonsillopharyngitis

Abstract number: P1288

Berzanskyte A., Valinteliene R., Palekauskaite A.

Objectives: The aim of the study was to evaluate influence of diagnostic tests to antibiotic prescribing and economical benefit.

Methods: Intervention study was carried out in two randomly selected outpatient (GP) clinics. Intervention consisted of 1) modern knowledge of diagnostics and appropriate antibiotic use for treatment of upper respiratory tract infections, particularly of tonsillopharyngitis, and 2) free rapid antigen detection test (RADT) for Group A hemolytic streptococcus (GABHS), recommendations for its use and interpretation of results. All cases (463) of tonsillopahryngitis from randomly selected patients, who visited GP in 2004, were included in control group. All cases (318) of tonsillopharyngitis from the patients, who visited GP in 2006, till the needed sample size was reached were included in reference group.

Results: After implementation of RADT increase in use of other diagnostic tests was noted. General blood test was performed 1.3 times (p = 0.03), erythrocyte sedimentation rate – 5.9 times (p = 0.00) more often, C-reactive protein test (CRP; not used before intervention at all) was started. The structure of prescribed antibiotics has changed. Penicillin was prescribed 5 times, clarythromycin and cephadroxyl 2 times more often, while broad spectrum penicillins as amoxicillin and amoxicillin with clavulanic acid decreased (respectively 2 and 5 times). Antibiotic prescription rate in general hasn't changed statistically significantly, as discrepancies of prescription rates in both clinics were found – it decreased 1.4 times (p = 0.02) in one clinic, but increased 1.2 times (p = 0.27) in another clinic. Positive RADT result necessitated 23 times more frequent antibiotic prescription than its negative result. However even getting negative RADT result, GPs prescribed antibiotics to 40.4% cases. Proportions of complications and recurrences decreased (respectively 2.1 and 3.7 times). However economical benefit in treatment of tonsillopharyngitis using RADT was gained just in one clinic. Characteristics of used in study RADT were determined: sensitivity 72.3%, specificity 92.3%, positive prognostic value 86.1%, negative prognostic value 83.5%.

Conclusions: After implementation of RADT, other diagnostic tests were used more often, importance of CRP was found in differential diagnosis of tonsillopharyngitis. Prescribed antibiotic structure has changed with the substantial increase of narrow spectrum penicillin.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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