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Single-centre, open-label, randomised, trial to compare rapid molecular point-of-care streptococcal testing to
Jeffrey M Pernica1, Fiona Smaill2, April J Kam3
1Paediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada pernica@mcmaster.ca.
Insights
This study evaluates a new rapid molecular test for streptococcal pharyngitis in children. The goal is to improve antibiotic prescribing accuracy and patient outcomes in pediatric emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Diagnostic Test Evaluation
Background:
- Streptococcal pharyngitis in children requires antibiotic treatment, but differentiating it from viral infections is challenging.
- Current diagnostic methods, including rapid antigen tests, have limitations in sensitivity and speed.
- Standard laboratory testing causes delays, potentially impacting appropriate antibiotic use and patient satisfaction.
Purpose of the Study:
- To determine if a novel rapid molecular point-of-care (POC) assay improves antibiotic prescribing for streptococcal pharyngitis in children.
- To compare the effectiveness of POC testing against standard laboratory-based testing in a pediatric emergency setting.
Main Methods:
- A randomized, superiority, open-label trial involving children aged 3+ presenting to a pediatric emergency department.
- Participants with a throat swab ordered for streptococcal pharyngitis will be enrolled, excluding those with recent antibiotic use or active infections.
- The primary outcome is appropriate antibiotic treatment at 3-5 days post-enrolment, with secondary outcomes including symptom resolution and satisfaction.
Main Results:
- This section is to be filled once the study results are available.
Conclusions:
- This section is to be filled once the study results are available.
Introduction:
Streptococcal pharyngitis, which commonly occurs in children, should be treated with antibiotics. Clinical prediction rules to differentiate streptococcal pharyngitis from viral infection are not recommended in children. Rapid point-of-care (POC) antigen tests have limited sensitivity and so are not often used in Canadian paediatric emergency departments (EDs). Standard paediatric practice is to rely on laboratory-based testing, which often results in a delay before the results can be communicated to the patient; this may impede appropriate prescribing, decrease caregiver satisfaction and delay recovery. The objective of this study is to determine whether a novel rapid molecular POC assay for streptococcal pharyngitis leads to more appropriate antibiotic use in children seeking care in a paediatric ED than standard laboratory-based testing.
Methods And Analysis:
A randomised, superiority, open-label, trial with two parallel groups. Children presenting to a tertiary paediatric ED at least 3 years of age who have a throat swab ordered for diagnosis of streptococcal pharyngitis will be eligible; those who have taken antibiotics within 72 hours prior to presentation and those with additional active infections will be excluded. The primary study outcome will be appropriate antibiotic treatment at 3-5 days postenrolment. Secondary outcomes include time to symptom resolution, caregiver satisfaction, caregiver/child absenteeism, number of subsequent healthcare visits, clinician satisfaction and incremental cost-effectiveness of POC testing. A total of 352 participants will be needed.
Ethics And Dissemination:
All study documentation has been approved by the Hamilton Integrated Research Ethics board and informed consent will be obtained from all participants. Data from this trial will be presented at major conferences and published in peer-reviewed publications to facilitate collaborations with networks of clinicians experienced in the dissemination of clinical guidelines.
Trial Registration Number:
NCT04247243.
