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[Introduction of rapid streptococcal antigen test: can its use improve adherence to antibiotic therapy?]
Anna Maria Bonet-Esteve1, Laia Font-Ribera2, Judit Dorca-Vila3
1Unitat de Farmàcia Atenció Primària. Gerència Territorial Catalunya Central. Institut Català de la Salut, Sant Fruitós de Bages, España; Grupo de Investigación PROSAARU (Promoción de la Salud en el Ámbito Rural), Gerència Territorial Catalunya Central. Institut Català de la Salut, Sant Fruitós de Bages, España.
Insights
A rapid strep test in children with pharyngotonsillitis reduced unnecessary antibiotic prescriptions. However, this test did not significantly improve antibiotic therapy adherence in pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Evidence-Based Medicine
Background:
- Pharyngotonsillitis is a common pediatric condition often treated with antibiotics.
- Accurate diagnosis is crucial to avoid overuse of antibiotics and manage patient adherence.
- Rapid streptococcal antigen tests offer quick diagnostic information in primary care settings.
Purpose of the Study:
- To assess the impact of rapid streptococcal antigen testing on antibiotic therapy adherence in pediatric pharyngotonsillitis.
- To evaluate if rapid strep test results influence prescribing patterns and patient compliance.
Main Methods:
- A randomized community clinical trial was conducted in primary care centers.
- Paediatric patients (3-15 years) with suspected pharyngotonsillitis were randomized into control and intervention groups.
- The intervention group received rapid streptococcal antigen testing to guide treatment, while the control group followed the standard algorithm. Adherence was assessed via telephone survey.
Main Results:
- Antibiotic prescription rates were significantly lower in the intervention group (45.5%) compared to the control group (88.5%).
- Overall antibiotic adherence was 64.8%, with medication scheduling failure being the primary cause of non-adherence (25.6%).
- While adherence was slightly higher in the intervention group (68%) versus the control group (62.9%), the difference was not statistically significant.
Conclusions:
- Rapid streptococcal antigen testing, when used with clinical criteria like Centor Criteria, effectively reduces unnecessary antibiotic prescriptions for pediatric pharyngotonsillitis.
- The study did not demonstrate a significant improvement in medication adherence through the use of rapid strep testing in this population.
- Further research may be needed to explore strategies for enhancing antibiotic adherence in pediatric respiratory tract infections.
Objective:
To evaluate the influence of the result of a rapid streptococcal antigen test in paediatric pharyngotonsillitis infections, in terms of improvement of antibiotic therapy adherence.
Design:
Randomized community clinical trial with two study groups.
Location:
Primary Care Centers in Central Catalonia.
Participants:
Patients aged from 3 to 15 years, who were attended at paediatric consultations on suspicion of pharyngotonsillitis caused by an infection between November 2010 and February 2011 (both included), were included in the study on a consecutive basis. 557 patients met the inclusion criteria and 519 were evaluated.
Intervention:
The control group received the usual diagnostic-therapeutic algorithm. Rapid streptococcal antigen test was additionally performed to experimental group participants and it was indicated the more convenient treatment.
Main Measurements:
Antibiotic adherence, non-adherence causes and socio-demographic risk factors were evaluated via telephone survey.
Results:
Antibiotics were prescribed to 65.6% and paediatricians of the control group were more likely to prescribe antibiotic than the ones in the intervention group (88.5% vs 45.5%, p< 0.0001). 64.8% followed doctor's treatment orders, being failure following medication scheduling the main cause of non-adherence (25.6%). Medication adherence was higher in the experimental group (68%) than in the control group (62.9%) but no significant differences were found.
Conclusion:
Rapid strep test, complementing the use of Centor Criteria avoids unnecessary antibiotics prescriptions, but had not been proven to be effective in increasing medication adherence.
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