Use of a clinical decision rule to diagnose streptococcal pharyngitis in hospital employees

Some people with pharyngitis have clinical findings that are suggestive of either streptococcal or nonstreptococcal disease. In this study the published results of the accuracy of a clinical decision rule are used to calculate the probable outcomes of withholding antibiotics from some hospital employees or giving others treatment presumptively without testing for group A streptococcal disease. Cost-benefit analysis shows explicitly how selective testing results in a trade-off among costs, the number of people given treatment unnecessarily, and the number with untreated disease that may spread within the hospital. The best strategy depends on judgment, taking into account the nature of the employee's patient contact, the needs of the hospital, and the resources for infection control.