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Evaluation of a rapid antigen detection test for the diagnosis of Streptococcal pharyngitis in children and its impact on antibiotic prescribing

Abstract number: P1378

Maltezou H., Tsagris V., Antoniadou A., Galani L., Biskini P., Douros K., Maragos A., Raftopoulos V., Fretzayas A., Nikolaidou P., Giamarellou H.

Objective: To study the performance of Becton-Dckinson Link 2 Strept A Rapid Test (RADT) in the diagnosis of streptococcal pharyngitis in children presenting with upper respiratory tract symptoms and fever and its impact on antibiotic prescribing

Methods: The study was a prospective non-randomised study in which private-practice and nosocomial paediatricians participated. Children 2–14 years old presenting with fever and at least one of: tender anterior cervical lymh nodes, tonsillar exudate or redness and absence of cough were enrolled in the study. Padiatricians were assigned in two groups: Group A which included only private-practice paediatricians who managed children only on clinical grounds and according to their usual clinical practice. They only had to fill a form with demographic data and information about the child's illness, their diagnosis and antibiotic prescribing. Group B consistent of private-practice (B1) and of nosocomial paediatricians (B2) who performed the RADT and a throat culture. Antibiotic prescribing in this group was guided by a positive RADT or culture. A similar data form was also filled as in group A.

Results: During the 2-year study period, 602 children were evaluated. Streptococcal pharyngitis was diagnosed by RADT and/or culture in 119 (36.6%) of the 325 children tested. The sensitivity, specificity, positive and negative predictive values of the RADT were 83.3%, 90.55, 83.8% and 93.3% respectively. A stepwise increase of Radt sensitivity was noted among children with 2, 3, or 4 clinical criteria (80.6% to 95.8%). By logistic regression analysis tender anterior cervical nodes and absence of cough were found to predict a positive throat culture (OR=4.381, CIs=1.106–17.355). Paediatricians of group A prescribed more frequently antibiotics compared to those of group B(82.3% versus 32.6%, p < 0.001). During the study no streptococcal pharyngitis related complications were noted and only one child presented with a rash as an allergic reaction to a cephalosporin

Conclusion: RADT presents with a reliable accuracy in the diagnosis of streptococcal pharyngitis in children, used in private practice and in the hospital. It is also associated with a significant reduction in antibiotic prescribing when used to guide therapy in children presenting with symptoms of pharyngitis. When only clinical criteria can are used, tender cervical lymph nodes and the absence of cough may predict streptococcal pharyngitis and guide therapy.

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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