Évaluation de l'applicabilité du consensus sur la prise en charge de l'angine chez l'adulte

Abstract

Objectives – The GRAPH group evaluated whether guidelines for the treatment of pharyngitis in adults (>25 years of age) based on the use of Strep A (StA) rapid diagnostic tests (RDT) were applicable in general practice. Methods – A pragmatic “before-after” study was made to evaluate changes in practice after training. This was done over three periods: period I “before” and III “after” in which data on GPs' practice (about 100 general practitioners (GPs) from the Bourgogne and Rhone Alpes regions) was collected; period II when GPs underwent training including information on the conclusions of the consensus conference and training to use the Strep A RDT. Results – Data was collected on GPs' practice in around 900 cases of pharyngitis in each period (I et III) between October 1998 and March 1999. After just one training course, RDTs were performed in 93% of cases, with a positive rate of 20.2%. The overall use of antibiotics was reduced by 48.4% (42.6% in period III vs. 82.6% in period I, p<0.001). Furthermore, the analysis of antibiotic prescription profiles confirmed that the current reference treatment for pharyngitis (penicillin V for 10 days) was rarely applied (⩽5% of the total antibiotics prescriptions). In terms of economic impact, the mean total treatment cost for an episode of pharyngitis was respectively 1,011.70 F and 898.70 F in period I and III (cost difference = 113 F). Conclusions – The current guidelines (SPILF, AFSSAPS) on the management of pharyngitis are applicable in general practice and appropriately followed.