[New strategies for angina case management in France].
Old French recommendations were to treat all pharyngitis cases to prevent acute rheumatic fever. 85 to 90% of cases were treated (8 to 9 millions/year), of which 3/4 unnecessary. Furthermore, penicillin V the drug of first choice was prescribed only to 5 to 10% of patients. Considering the preocupating increase of bacterial resistances and the disponibility of performane Group A Beta-Hemolytic Streptococcus Rapid Diagnostic Test (Negative Predictive Value above 95%), the new management strategy is proposed in two ways. Firstly, the free delivery of RDT to practitioners which was associated in Burgundy with a dramatic prescription decrease to 41% without benefice lost for patients. Considering these good results the French authorities decided the generalization of RDT use in 2002 and more than 15,000 practitioners have been concerned by the formations delivered in 3 months. Secondly, the short course treatment assays initiated by our group have been validated and since 2002 the AFSSAPS recommend the preferential use of compounds which obtained the authorization of use in short course with a new indication incitating to document GABHS pharyngitis by the RDT use.
Service des maladies infectieuses et tropicales, Hôpital du Bocage, BP 77908-21079 Dijon.
Henri
H
Portier
Michèle
M
Grappin
Pascal
P
Chavanet
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001431:Bacteriological Techniques; D019090:Case Management / Q000639:trends*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000639:trends; D005602:France; D006801:Humans; D007223:Infant; D010353:Patient Education as Topic; D010612:Pharyngitis / Q000175:diagnosis / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000639:trends; D011237:Predictive Value of Tests; D012213:Rheumatic Fever / Q000517:prevention & control; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy*; D013297:Streptococcus pyogenes / Q000302:isolation & purification
D000900:Anti-Bacterial Agents