JAC Advance Access originally published online on September 11, 2008
Journal of Antimicrobial Chemotherapy 2008 62(6):1407-1412; doi:10.1093/jac/dkn376
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Original research |
Evaluation of a rapid antigen detection test in the diagnosis of streptococcal pharyngitis in children and its impact on antibiotic prescription
1 Office for Nosocomial Infections, Antimicrobial Resistance, and Rational Use of Antibiotics, Hellenic Center for Disease Control and Prevention, Athens, Greece 2 3rd Department of Pediatrics, University of Athens, University General Hospital ATTIKON, Athens, Greece 3 4th Department of Internal Medicine, University of Athens, University General Hospital ATTIKON, Athens, Greece 4 Nursing Department, Cyprus University of Technology, Nicosia, Cyprus
Received 2 April 2008; returned 13 May 2008; revised 12 July 2008; accepted 5 August 2008
* Corresponding author. Tel: +30-210-5831-990; Fax: +30-210-5326-446; E-mail: hgiama{at}ath.forthnet.gr
Objectives: To study the performance of the Becton-Dickinson Link 2 Strep A Rapid Test, a rapid antigen detection test (RADT) for diagnosing streptococcal pharyngitis in children presenting to private offices and to the Pediatric Outpatient Clinic of a university hospital, in relation to clinical criteria (fever, tender anterior cervical lymph nodes, tonsillar exudate and absence of cough), and its impact on antibiotic prescription.
Methods: Children were enrolled in Group A (enrolment by private-practice paediatricians; diagnosis by clinical picture only), Group B (enrolment by private-practice paediatricians; diagnosis by RADT and culture) or Group C (enrolment by hospital-affiliated paediatricians in the Pediatric Outpatient Clinic; diagnosis by RADT and culture).
Results: During a 2 year period, 820 children were enrolled [369 (45%) in Group A, 270 (33%) in Group B and 181 (22%) in Group C]. Streptococcal pharyngitis was diagnosed by RADT and culture in 146 (32.4%) of the 451 tested children. The sensitivity, specificity and positive and negative predictive values of the RADT were 83.1%, 93.3%, 82.4% and 93.6%, respectively. A stepwise increase in the sensitivity of the RADT was noted among children with one, two, three or four clinical criteria (60.9% to 95.8%). Paediatricians without access to laboratory tests were more likely to prescribe antibiotics compared with paediatricians with access to tests (72.2% versus 28.2%, P < 0.001). Private-practice paediatricians prescribed antibiotics more frequently compared with hospital-affiliated paediatricians (55.7% versus 19.9%, P < 0.001).
Conclusions: Our findings support screening of all children with pharyngitis for Centor criteria and subsequently performing an RADT to guide decision for antibiotic administration. Such a strategy has an important impact on limiting throat culture testing and is associated with reduced antibiotic prescription.
Keywords: clinical criteria , RADT , streptococci