Abstract
BackgroundAcute pharyngitis is one of the most frequent consultations to the general practitioner and in most of the cases an antibiotic is prescribed in primary care in Spain. Bacterial etiology, mainly by group A beta-hemolytic streptococcus (GABHS), accounts for 10-20% of all these infections in adults. The purpose of this study is to assess the impact of rapid antigen detection testing (RADT) to identify GABHS in acute pharyngitis on the utilization of antibiotics in primary care.Methods/designMulticentric randomized controlled trial in which antibiotic prescription between two groups of patients with acute pharyngitis will be compared. The trial will include two arms, a control and an intervention group in which RADT will be performed. The primary outcome measure will be the proportion of inappropriate antibiotic prescription in each group. Two hundred seventy-six patients are required to detect a reduction in antibiotic prescription from 85% in the control group to 75% in the intervention group with a power of 90% and a level of significance of 5%. Secondary outcome measures will be specific antibiotic treatment, antibiotic resistance rates, secondary effects, days without working, medical visits during the first month and patient satisfaction.DiscussionThe implementation of RADT would allow a more rational use of antibiotics and would prevent adverse effects of antibiotics, emergence of antibiotic resistance and the growth of inefficient health expenses.Trial registrationISRCTN23587778
Highlights
Acute pharyngitis is one of the most frequent consultations to the general practitioner and in most of the cases an antibiotic is prescribed in primary care in Spain
Acute pharyngitis is frequently seen in primary care for which uncertain etiology may result in inappropriate management
Most pharyngotonsillitis are viral in origin while group A b-hemolytic Streptococcus (GABHS) is the most common bacterial cause of acute pharyngitis, accounting for approximately 15% to 30% of the cases in children and 5% to 15% of cases in adults [2]
Summary
Acute pharyngitis is frequently seen in primary care for which uncertain etiology may result in inappropriate management. In Spain, rapid antigen detection tests (RADT) are seldom used in general practice and physicians still rely on the Centor criteria -fever, tonsillar exudates, tender vertical nodes, and/or absence of cough- for prescribing antibiotic therapy [10]. Low-cost and rapid immunological techniques targeting the detection of GABHS antigens have been developed for use in the clinical setting. Their high specificity (>95) make the probability of obtaining false positive results very low [11,12,13]. Very few studies have been carried out to know the impact of RADT on the pattern of how general practitioners prescribe antibiotics for patients with pharyngotonsillitis in adults.
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