Are Symptoms Sufficient in the Decision to Start Antibiotics in Tonsillopharyngitis?

Unnecessary use of antibiotics is one of the causes of antibiotic resistance. Rapid Antigen Test (RAT) is recommended to prevent unnecessary use of antibiotics by providing bacteria/virus isolation in patients with tonsillopharyngitis. However, in patients with typical symptoms, false-negative test results may lead to doubt in doctors. In this study, we aimed to evaluate the relationship between patients' symptoms and RAT results.

In this study, we chose the patients that referred to the University of Health Sciences (SBÜ) Şişli Hamidiye Etfal Training and Research Hospital Family Medicine Polyclinics and got a diagnosis of tonsillopharyngitis with RAT. This study was conducted by a retrospective file scanning method. We examined the age, sex, symptoms, RAT results and throat culture results of the patients. SPSS 15.0 for Windows program was used for the statistical analysis. The level of statistical significance was accepted as p<0.05.

In this study, the RAT of 265 patients and the throat culture of 141 patients were examined. We found RAT positivity as 28.7%, Group A Beta Hemolytic Streptococcus (AGBHS) detection rate in throat culture was 22.5%, and the antibiotic prescription rate was 37%. There were 32 patients with AGBHS positivity in throat culture. Twenty-seven of them got RAT positivity, too. When symptoms and RAT positivity were examined, there was no significant relationship between RAT positivity and fever higher than 38 oC, but RAT was more often positive in patients with a fever higher than 38 oC. On the other hand, there is a statistically significant relationship between RAT positivity and the presence of tonsillar exudate (p=0.000). When the relationship between symptoms and RAT according to age groups was examined, the presence of LAP and tonsillitis were significant (p=0.000; p=0.001). In the age group of 18 years and over, the presence of tonsillar exudates was significant (p=0.001).

In our study, tonsillar exudate was a common symptom in both age groups of <18, and ≥18 years of age; at the same time, there is a statistically significant relation with RAT. Tonsillar exudates are not seen only in bacterial infections but also in viral infections. Thus, we think that antibiotics should not be started based on symptoms, and RAT should be used effectively.