Abstract
Objectives: To investigate the effect of rapid antigen testing (RAT) on the practice of antibiotic prescription as well as the accuracy of peripheral blood neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) values in detecting group A beta-hemolytic Streptococcus (GABHS) in children with tonsillopharyngitis.Methods: In a multicenter study performed in Turkey, we retrospectively analyzed data from 668 consecutive pediatric patients under 17 years of age, who presented with signs and symptoms of tonsillopharyngitis and underwent RAT. The rates of positive and negative RAT results were determined and patients' antibiotic prescriptions were examined in relation to RAT results. In addition, the accuracy of peripheral blood NLR and CRP values was examined for 212 patients whose laboratory data were available, with RAT as the reference standard.Results: Positive RAT results were observed in 190 of 668 (28.4%) patients. Antibiotics were prescribed to all 190 patients with positive RAT results and to 8 of 478 patients with negative RAT results. Overall, the rate of antibiotic prescription was 29.6%. Patients with positive and negative RAT results did not differ significantly with regard to NLR and CRP values. In ROC analysis, the area under the ROC curve (AUC) of NLR and CRP were 0.54 (95% confidence interval [CI] 0.45–0.64), and 0.55 (95% CI 0.45–0.65), respectively.Conclusion: RAT results proved highly associated with antibiotic prescribing, suggesting that RATs could be of great value in preventing unnecessary antibiotic use. Our findings also suggest that NLR and CRP are poorly accurate to identify GABHS in children with tonsillopharyngitis.
Highlights
Tonsillopharyngitis is a common upper respiratory tract infection (URTI) in children, mainly associated with viruses, manifesting as acute inflammation of the tonsils and pharynx
We investigated the association between Rapid antigen-detection tests (RAT) results for group A beta-hemolytic Streptococcus (GABHS) and antibiotic prescribing in children under 17 years of age, who were diagnosed with URTI and had signs and symptoms of tonsillopharyngitis
The inclusion criteria comprised: children under 17 years of age, who presented with signs and symptoms of tonsillopharyngitis, and who underwent RAT because of a diagnosis of URTI with an initial suspicion of GABHS based on scores of 2 or higher according to the modified Centor criteria (Figure 1 and Table 1) [18]
Summary
Tonsillopharyngitis is a common upper respiratory tract infection (URTI) in children, mainly associated with viruses, manifesting as acute inflammation of the tonsils and pharynx. Whether GABHS are promptly diagnosed or ruled out is of particular importance in that a positive test result would prompt antibiotic use by indication while a negative test result would deter from antibiotic use. This is beneficial to patients by reducing unnecessary antibiotic use, and in turn, adverse drug reactions and antibiotic resistance, and in favor of the society as a whole in the context of decreasing overall antibiotic resistance and reducing health-care expenditures [8]. The use of RATs has been shown to be influential in decreasing the rates of antibiotic prescription [9,10,11]
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