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Association Between Rapid Antigen Testing and Antibiotic Use and Accuracy of Peripheral Blood Parameters in Detecting

Yakup Cag1, Abdurrahman Avar Özdemir2, Ufuk Yükselmiş1

  • 1Department of Pediatrics, Kartal Dr. Lutfi Kırdar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Frontiers in Pediatrics
|August 21, 2019
PubMed

Insights

Rapid antigen testing (RAT) significantly influences antibiotic prescribing for pediatric tonsillopharyngitis, reducing unnecessary use. Neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) are inaccurate for detecting group A Streptococcus in children.

Area of Science:

  • Pediatric infectious diseases
  • Clinical diagnostics
  • Antimicrobial stewardship

Background:

  • Tonsillopharyngitis is a common pediatric illness, often leading to antibiotic prescriptions.
  • Accurate diagnosis of group A beta-hemolytic Streptococcus (GABHS) is crucial to avoid unnecessary antibiotic use.
  • Rapid antigen testing (RAT), neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP) are potential diagnostic tools.

Purpose of the Study:

  • To evaluate the impact of RAT on antibiotic prescribing practices in pediatric tonsillopharyngitis.
  • To assess the diagnostic accuracy of NLR and CRP for detecting GABHS in children with tonsillopharyngitis.

Main Methods:

  • Retrospective analysis of 668 pediatric patients (<17 years) with tonsillopharyngitis who underwent RAT.
  • Examination of antibiotic prescription rates based on RAT results.
  • Evaluation of NLR and CRP accuracy using RAT as the reference standard in a subset of 212 patients.

Main Results:

  • RAT results were positive in 28.4% of patients.
  • Antibiotics were prescribed to all patients with positive RAT results and to a small proportion with negative results, totaling 29.6% overall.
  • NLR and CRP showed poor accuracy (AUC ~0.55) in identifying GABHS, with no significant difference between positive and negative RAT groups.

Conclusions:

  • RAT is strongly associated with antibiotic prescribing decisions, indicating its potential to curb unnecessary antibiotic use.
  • NLR and CRP are not reliable biomarkers for diagnosing GABHS in pediatric tonsillopharyngitis.
  • Implementing RAT can aid in appropriate antibiotic stewardship for pediatric upper respiratory tract infections.

Keywords:
bacterial antigenschilddrug prescriptionsimmunoenzyme techniquesstreptococcal infectionstonsillopharyngitis

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