Office diagnosis and management of group A streptococcal pharyngitis employing the rapid antigen detecting test. A 1-year prospective study of reliability and cost in primary care centres.
The impact of introducing the rapid antigen detecting test for the diagnosis of group A streptococcal pharyngitis in primary care centres and the direct and comprehensive cost-effectiveness of four alternative strategies for the management of group A streptococcal pharyngitis and the prevention of rheumatic fever were assessed in a 1-year prospective randomized study, carried out in children between the ages of 5 and 14 years. Data from the study showed that the test was easy to perform and reliable when introduced as a service in primary care. The strategy of using the rapid antigen detecting test and a 10-day oral penicillin course for diagnosis and treatment proved to be the safest and most cost-effective. If compliance with a 10-day course of oral penicillin is unlikely to be achieved, the strategy of introducing the test and treatment by intramuscular benzathin penicillin G proved to be the second best cost-effective alternative. In developing countries, where acute rheumatic fever is still common and the cost of the test and a 10-day course of penicillin may prove to be formidable, a strategy of treating all children with pharyngitis with intramuscular benzathin penicillin G seems to be the most cost-effective. The strategy of diagnosing group A streptococcal pharyngitis on clinical grounds proved to be the worst.
Majeed
H A
HA
Department of Pediatrics, Faculty of Medicine, University of Kuwait.
al-Doussary
L
L
Moussa
M M
MM
Yusuf
A R
AR
Suliman
A H
AH
D000293:Adolescent; D000554:Ambulatory Care Facilities; D000942:Antigens, Bacterial / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D010401:Penicillin G Benzathine / Q000191:economics* / Q000627:therapeutic use; D010404:Penicillin V / Q000191:economics* / Q000627:therapeutic use; D010612:Pharyngitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D010614:Pharynx / Q000382:microbiology; D011320:Primary Health Care; D011446:Prospective Studies; D015203:Reproducibility of Results; D012213:Rheumatic Fever / Q000517:prevention & control; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000276:immunology / Q000302:isolation & purification
D000942:Antigens, Bacterial; D010401:Penicillin G Benzathine; D010404:Penicillin V