Use Of Rapid Antigen Detection Test Research Articles

Real-world performance of SARS-CoV-2 rapid antigen testing through the Alpha-, Delta- and Omicron-dominant waves of the COVID-19 pandemic

ObjectivesCompared with reverse transcription polymerase chain reaction (RT-PCR), rapid antigen detection tests (RADTs) for SARS-CoV-2 diagnostics are faster, less expensive, but also less accurate. Performance of RADTs is context-specific and depends on disease prevalence. In this real-world study, we assessed impact of RADTs in an inpatient setting through the entire COVID-19 emergency phase. MethodsIn this matched retrospective study, data on RT-PCR and RADT laboratory diagnoses of SARS-CoV-2 made between February 2020 and May 2023 in a large hospital were analyzed. To be included in the study, samples used for both RT-PCR and RADT had to be collected on the same day. ResultsOf 278,867 RT-PCR tests available, 13,321 same-day RADTs could be matched to RT-PCR. Over the entire period, RADT sensitivity and specificity were 76.4% and 99.4%, respectively. With the observed positivity rate of 9.4%, positive and negative predictive values were 92.7% and 97.6%, respectively. Compared with the periods dominated by the Alpha and Delta variants of concern, RADT accuracy was slightly lower during the Omicron phase. ConclusionThis real-world experience demonstrates that despite suboptimal sensitivity and some variation by predominant variants of concern and positivity prevalence, the use of RADTs is useful in hospital settings. Public health implications were discussed.

Characteristics of the sore throat test and treat service in community pharmacies (STREP) in Wales: cross-sectional analysis of 11 304 consultations using anonymized electronic pharmacy records.

An NHS-funded sore throat test and treat (STTT) service was introduced in selected community pharmacies in Wales. Service users were screened using FeverPAIN/Centor scores, offered rapid antigen detection testing (RADT) to detect group A Streptococcus if appropriate, and supplied with antibiotics (by the pharmacist) if indicated. Following an initial evaluation, the service was rolled out nationally. This study forms part of the long-term STTT evaluation. The aim was to describe characteristics of the service and service users, the delivery, service outcomes, patient safety and antibiotic prescribing. Cross-sectional descriptive study using anonymized individual-level data from electronic pharmacy records of all eligible STTT service users between November 2018 and February 2020. We identified 11 304 pharmacy STTT consultations in service users aged 6 years and over, with a median age of 25 years (IQR: 12 to 44). RADT was undertaken in 8666 (76.7%) consultations with 2503 (28.9% of RADT) positive tests. In total, 2406 (21.3%) service users were supplied with antibiotics. Pharmacists managed 91% of consultations in the pharmacy and referred only 937 (9.3%) service users to a GP and 27 (0.2%) to the Emergency Department. Higher rates of antibiotic supply were observed in out-of-hours consultations when compared with in-hours (24.9% versus 20.9%). This is the largest description of a pharmacy-led STTT service to date and suggests it can be delivered at scale to align with a pre-specified pathway that promotes appropriate use of RADT and antibiotics. The service could substantially reduce workload from a common illness in other heavily pressurized areas of primary and emergency care.

De-isolation of vaccinated COVID-19 health care workers using rapid antigen detection test

BackgroundCOVID-19 de-isolation guidelines of health care workers (HCW) were formulated based on evidence describing the duration of infectious viral shedding of the wild SARS-CoV-2 virus. During the periods of COVID-19 vaccination and variants, a test-based approach was recommended to end isolation of HCW, based on emerging data describing the viral kinetics of COVID-19 variants. While Rapid antigen detection tests (RADT) are increasingly used in the diagnosis of COVID-19, their use is limited in de-isolation. MethodsWe described the use of RADT in the de-isolation of COVID-19 vaccinated HCW with mild infection who were asymptomatic on day 7 post diagnosis in a single center retrospective cohort study during the Omicron surge. ResultsOf the 480 HCWs, 173 (36%) had positive RADT. The positivity rate of RADT was not different in HCW who received two doses versus three doses of vaccine (34.4% versus 40.3%, p = 0.239). ConclusionsA symptom based, test-based approach using RADT is a useful tool in the de-isolation of HCW, with mild disease, in the era of Omicron. Further studies are required to evaluate the role of RADT in de-isolation of patients with severe COVID-19 disease.

Effectiveness of rapid antigen testing for screening of asymptomatic individuals to limit the transmission of SARS-CoV-2: A rapid review.

Rapid antigen detection tests (RADTs) offer advantages over gold‐standard reverse transcription polymerase chain reaction (RT‐PCR) tests in that they are cheaper and provide faster results, thus enabling prompt isolation of positive SARS‐CoV‐2 cases and quarantine of close contacts. The aim of this study was to collate and synthesise empirical evidence on the effectiveness of rapid antigen testing for the screening (including serial testing) and surveillance of asymptomatic individuals to limit the transmission of SARS‐CoV‐2. A rapid review was undertaken in MEDLINE (EBSCO), EMBASE (OVID), Cochrane Library, Europe PMC and Google Scholar up until 19 July 2021, supplemented by a grey literature search. Of the identified 1222 records, 19 reports referring to 16 studies were included. Eight included studies examined the effectiveness of RADTs for population‐level screening, four for pre‐event screening and four for serial testing (schools, a prison, a university sports programme and in care homes). Overall, there is uncertainty regarding the effectiveness of rapid antigen testing for the screening of asymptomatic individuals to limit the transmission of SARS‐CoV‐2. This uncertainty is due to the inconsistent results, the relatively low number of studies identified, the predominantly observational and/or uncontrolled nature of the study designs used, and concerns regarding methodological quality. Given this uncertainty, more real‐world research evidence in relevant settings, which is of good quality and timely, as well as economic evaluation, is required to inform public policy on the widespread use of RADTs in asymptomatic individuals.

Performance evaluation of three rapid antigen tests for the diagnosis of group A Streptococci

ObjectiveTo compare the diagnostic performance of three rapid antigen detection tests (RADTs) for group A Streptococcus (GAS).DesignA hospital-based, cross-sectional, retrospective study.SettingA comparative study of rapid diagnostic tests for GAS using...

Antibiotic prescription before and after rapid antigen detection test (RADT) for beta-hemolytic streptococci

Objectives: Acute pharyngo-tonsillitis is one of the diseases that pediatricians and general practitioners most frequently experienced and only a small percentage of patients (20%-30% of pediatric patients, even less in adults) are actually suffering from pharyngo-tonsillitis by group A beta-hemolytic Streptococcus (GABHS). Also three quarters of pharyngitis patients have been treated with inappropriate antibiotics even these patients have viral infections. The aim of this study was to assess the effectiveness of the rapid antigen detection test (RADT) on the percentage of antibiotic prescriptions amongst patients with sore throat at a primary health care center in rural area. Methods: Retrospective Cohort Study was designed to compare antibiotic prescription in patients with sore throats in two groups, one with the use of RADT and other with the clinical desicions of physicians. The x2 test was used between two nominal variables to assess the impact of RADT on antibiotic prescription. For comparison of more than two independent variables, the ANOVA test was used and to identify the differences between groups, the Post-Hoc test was processed. Results: Of the 580 patients, the avarage age of the study population was 25.8 years old while the median age was 21 years (min.=3, max.=65). There was a significant difference between two groups who had tested with RADT or not in terms of antibiotic prescription (p < 0.001). There was a significant difference between 3-14 years of age and 15-44 years of age (p = 0.001) as well as 3-14 years of age and 45-65 years of age (p = 0.009), however there was no significant difference between 15-44 and 45-65 years of age (p = 1.00). Conclusions: Using the RADT is truly effective in reducing the percentage of antibiotic prescriptions in our setting. We believe that, the tools like RADTs which are quickly results and easy to use are really useful in practising (particularly in rural area).

LO46: The impact of rapid antigen detection testing on antibiotic prescription for acute pharyngitis: a systematic review and meta analysis

Introduction: Acute pharyngitis is a common reason for primary care or emergency department visits, often resulting in antibiotic prescription. Rapid antigen detection tests (RADT) are routinely used to diagnose Group A Streptococcus (GAS) pharyngitis. However, due to its low sensitivity, patient pressures and conflicting guidelines, the RADT often complicates management decisions. Our aim was to assess the impact of RADT in patients presenting with acute GAS pharyngitis on the antibiotic prescription rate and appropriateness of antibiotic management. Methods: We systematically searched Medline, Embase, and Cochrane databases from 1980 to June 2016. Studies were selected according to a predefined PRISMA protocol and data extracted by two independent reviewers. Prospective and retrospective studies that evaluated the impact of RADT on antibiotic prescription for pharyngitis were included. Study quality was assessed using Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. Our main outcome was a dichotomous measure of antibiotic prescription, with or without RADT availability. Studies were combined if there was low clinical and statistical heterogeneity (I2<30%). Bivariate Mantel-Haenszel random effects model was used to perform meta analyses using SPSS 22 and Revman 5. Results: We identified 4003 studies: 139 were selected for full text review; 10 met our inclusion criteria (N=10859 participants, median age 31 years, 56.7% female). Mean antibiotic prescription rate in the RADT and control arm was 38.2% (SD 15.6) and 55.9% (SD 16.3), respectively. The use of RADT was associated with lower antibiotic prescription rate in both adults (OR=0.60 [95% CI 0.45-0.80], I2=8%, N=1407) and pediatrics (OR=0.49 [95% CI 0.44-0.55], I2=5%, N=976). There was no overall difference (p<0.3) in antibiotic prescription rate among disease severity (Centor scores 1-4). The use of RADT did not significantly impact the appropriateness of antibiotic management (OR=1.15 95% CI 0.94-1.5). Conclusion: The use of RADT is associated with a reduction in antibiotic prescription for patients with GAS pharyngitis without an increase in appropriate antibiotic use. Despite low prevalence of the disease in the population, antibiotic prescription rates are still high. These findings suggest great potential for antibiotic stewardship and reevaluation of current guidelines for managing GAS pharyngitis.

Near-patient tests and the clinical gaze in decision-making of Swedish GPs not following current guidelines for sore throat - a qualitative interview study.

BackgroundExcessive antibiotics use increases the risk of resistance. Previous studies have shown that the Centor score combined with Rapid Antigen Detection Test (RADT) for Group A Streptococci can reduce unnecessary antibiotic prescribing in patients with sore throat. According to the former Swedish guidelines RADT was recommended with 2–4 Centor criteria present and antibiotics were recommended if the test was positive. C- reactive protein (CRP) was not recommended for sore throats. Inappropriate use of RADT and CRP has been reported in several studies.MethodsFrom a larger project 16 general practitioners (GPs) who stated management of sore throats not according to the guidelines were identified. Half-hour long semi-structured interviews were conducted. The topics were the management of sore throats and the use of near-patient tests. Qualitative content analysis was used.ResultsThe use of the near-patient test interplayed with the clinical assessment and the perception that all infections caused by bacteria should be treated with antibiotics. The GPs expressed a belief that the clinical picture was sufficient for diagnosis in typical cases. RADT was not believed to be relevant since it detects only one bacterium, while CRP was considered as a reliable numerical measure of bacterial infection.ConclusionsInappropriate use of near-patient test can partly be understood as remnants of outdated knowledge. When new guidelines are introduced the differences between them and the former need to be discussed more explicitly.

Rapid Group a Streptococcus Antigen Test (Radt) Usage and Expediency in Diagnosis and Treatment of Pharyngotonsillitis in Family Physician Practice

Background. Group A streptococcus (S. pyogenes) is responsi- ble for 5 – 20% of cases of pharyngitis in adults and 15 to 20% of cases in children. Most common diagnostic tests are throat culture and rapid antigen detection testing (RADT). The modified Centor criteria can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing or empiric antibiotic therapy. Objective. Evaluate the rapid group A streptococcus antigen test (RADT) usage and expediency in family physician practice. Goals. To analyze children aged between 3 - 15 who suffers from acute pharyngitis ≥ 3 times per year and have ≥ 3 modified Centor criteria; to evaluate the ease of use of RADT in family phy- sician practice; to identify the correlation between RADT and the clinical symptoms of the acute pharyngitis and between the RADT and the blood test results; to evaluate the importance of RADT in diagnosing the acute pharyngitis and choosing treatment strategy. Methods. The study was accomplished in 2011-2013. 108 children aged between 3 and 15 and who suffers from acute pha- ryngitis > 2 times per year, plus have ≥ 3 modified Centor criteria were investigated. Prospectively all patients were tested by RADT. Also, the prescribed treatment and its effectiveness were analyzed. Statistical facts analysis was performed by using „SPSS 17.0“ and „MS Excel“ programs. Results. Girls suffer more often than boys from acute pha- ryngotonsillitis. The age average of patients was 7,22 ± 3,532. On average, patients appealed to doctor after 2-3 days of illness. RADT was positive in 32 (29.6%) children. Moreover, RADT was more often positive (42%) for children in 7-10 years old group, also for children who had 5 modified Centor criteria (62% of all positive cases). Conclusion. No statistically significant difference was obtained between the clinical symptoms and treatment effectiveness for children with a positive or negative result in RADT. However, all patients with positive RADT and who were taking Phenoxymethyl- penicillin recovered in 10 days. Moreover, obtained data shows that RADT test will facilitate the correct diagnosis and the tactics of selecting the treatment.

Promoting prudent use of antibiotics: the experience from a multifaceted regional campaign in Greece.

BackgroundAntibiotic resistance, a major public health problem, has been linked to antibiotic consumption. In Greece both consumption and resistance rates are among the highest in Europe. A multifaceted campaign targeting both physicians and parents of school children was implemented for the first time in order to educate the public and update doctors, aiming to promote judicious use of antibiotics and hopefully decrease its consumption.MethodsThe programme consisted of a public education campaign and academic detailing of primary care physicians in the district of Corinth in Peloponnese. The experience and perceptions of parents were recorded in the meetings in the form of course evaluation and assessment, anonymous questionnaires. The use of Rapid Antigen Detection Test (RADT) for streptococcal pharyngitis by primary care physicians was also assessed by use of anonymous questionnaires. Antibiotic consumption was compared before and after the programme between the district of Corinth and the other districts of Peloponnese, as well as at a national level.ResultsAntibiotic consumption remained unaltered at 26 Defined daily doses per 1000 Inhabitants per Day (DID) in accordance with the trend in other regions and at a national level. However, the utilization of Amoxycillin and Penicillin was increased by 34.3%, while the use of other antimicrobial classes including macrolides, cephalosporins and fluoroquinolones decreased by 6.4-21.9%. The use of RADT did not lead to a significantly decreased antimicrobial consumption.ConclusionsA multifaceted educational programme targeting both the general public and primary care physicians was associated with rationalization in the choice of antimicrobial. A reduction in the total antimicrobial consumption was not achieved.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-866) contains supplementary material, which is available to authorized users.

Impact on antibiotic prescription of rapid antigen detection testing in acute pharyngitis in adults: a randomised clinical trial.

Acute pharyngitis is one of the most frequent reasons for a GP consultation, and in most cases an antibiotic is prescribed. To determine the impact of rapid antigen detection testing (RADT) to identify group A beta haemolytic streptococcus in acute pharyngitis on the utilisation of antibiotics and appropriateness of their use. Cluster randomised controlled trial in primary care centres in Catalonia, Spain. Patients with acute pharyngitis aged 14 years or older with at least one Centor criterion (fever, tonsillar exudate, tender enlarged anterior cervical lymph nodes, or absence of cough) were recruited. Participant physicians were randomly assigned to one of two study arms: an intervention group (assigned to RADT) and a control group (following usual care, without RADT). Of the 557 adults enrolled, 543 could be evaluated for analysis (281 [51.7%] in the intervention group and 262 [48.3%] in the control group). GPs without access to RADT were more likely to prescribe antibiotics compared with those who performed rapid tests (64.1% versus 43.8%, P<0.001). The more Centor criteria the patients presented, the greater the number of antibiotics prescribed, regardless of whether RADT was available (P<0.001). Antibiotics were prescribed in 30.7% of the cases with negative RADT results. Inappropriate antibiotic prescription was observed in 226 cases (43%), and was significantly greater in the control than in the intervention group (60% versus 26.9%; P<0.001). Even though more than 30% of negative RADT results resulted in antibiotic prescribing, the study findings support the use of RADT in the consultation. This strategy has an important impact on reducing antibiotic prescription among adults with acute pharyngitis.

Association between use of rapid antigen detection tests and adherence to antibiotics in suspected streptococcal pharyngitis

Objective. Few studies have analysed adherence to antibiotic treatment in pharyngitis. The aim of this study was to evaluate the association of rapid antigen detection tests (RADT) and treatment adherence among patients 18 years of age or over with pharyngitis treated with different antibiotic regimens. Design. Prospective study from 2003 to 2008. Setting. Office-based physician practices. Intervention. The adherence of patients prior to the use of RADTs – no test was available until mid-2006 – was compared with the adherence associated with the use of RADTs. Subjects. Patients with suspected streptococcal pharyngitis. Main outcome measures. Patient adherence was assessed by electronic monitoring. The adherence outcomes considered were antibiotic-taking adherence, correct dosing, and good timing adherence during at least 80% of the antibiotic course. Results. A total of 196 patients were recruited. The percentage of container openings was 77.9%±17.7%, being significantly higher for patients in whom the RADTs were performed compared with those in whom this test was not undertaken (80.1% vs. 70.8% for thrice-daily antibiotic regimens and 88.1% vs. 76.5% for twice-daily regimens; p < 0.01). The other variables of adherence were also better among patients undergoing RADT in both those who took at least 80% of the pills (71.3% vs. 42.2%; p < 0.001) as well as those with good timing adherence (52.5% vs. 32.8%; p < 0.01). Furthermore, correct dosing was always greater when the patient had undergone an RADT. Conclusion. Adherence to antibiotic treatment is higher when an RADT is carried out at the consultation prior to administration of antibiotic treatment.

In vitro evaluation of five rapid antigen detection tests for group A beta-haemolytic streptococcal sore throat infections

Using accurate and easy to use rapid antigen detection tests (RADTs) to identify group A beta-haemolytic Streptococci (GABHS) sore throat infections could reduce unnecessary antibiotic prescribing and antimicrobial resistance. Although there is no international consensus on the use of RADTs, these kits have been widely adopted in Finland, France and the USA. Yet in the UK, the Clinical Knowledge Summaries, that provide the main online guidance for GPs, discourage RADTs use, citing their poor sensitivity and inability to impact on prescribing decisions in acute sore throat infections. The purpose of this study was to evaluate the ease of use and in vitro accuracy (sensitivity and specificity) of the five most commonly used RADTs in Europe (OSOM Ultra, Quickvue Dipstick, Streptatest, Clearview Exact Strep A and IMI Test Pack). To ensure the RADTs were evaluated objectively, a standardized in vitro method using known concentrations of GABHS was used to remove the inherent biases associated with clinical studies. The IMI Test Pack was the easiest RADT to use overall. The ability to detect all positive GABHS (sensitivity) varied considerably between kits from 95% [95% confidence interval (CI): 88-98%], for the IMI Test Pack and OSOM, to 62% (95% CI: 51-72%) for Clearview, at the highest GABHS concentration. None of the RADTs gave any false-positive results with commensal flora-they were 100% specific. The IMI Test Pack is most suitable for use in primary care, as it had high sensitivity, high specificity and was easy to use.