Diagnosing streptococcal sore throat in adults: randomized controlled trial of in-office aids.
OBJECTIVE
To determine whether use of clinical decision rules or rapid streptococcal antigen detection tests (alone or in combination) can lower the number of unnecessary prescriptions for antibiotics for adults with acute sore throats.


METHODS
Four-arm randomized controlled trial.


METHODS
Family practice offices in eastern Newfoundland.


METHODS
Forty urban and suburban family practitioners.


METHODS
Participants were randomly assigned to one of 4 arms (usual practice, decision rules only, rapid antigen test only, decision rules and antigen test combined), and each recruited successive adult patients presenting with acute sore throat as their main symptom. Following usual care or use of decision rules or rapid antigen tests or both (where applicable), physicians were to record what they prescribed for each patient.


METHODS
Prescribing rates and types of antibiotics prescribed.


RESULTS
The prescribing rate using decision rules (55%) did not differ significantly from the rate using usual clinical practice (58%). Physicians using rapid antigen tests, both alone and with decision rules, had significantly lower prescribing rates (27% and 38%, respectively, both P < .001).


CONCLUSIONS
Evidence-based clinical decision rules alone do not change family doctors' prescribing behaviour. Use of rapid antigen tests might allow physicians to persuade patients that negative results (and hence, viral infection) mean antibiotic therapy is not required.
Worrall
Graham
G
Memorial University of Newfoundland, St John's. gworrall@mun.ca
Hutchinson
James
J
Sherman
Gregory
G
Griffiths
Joseph
J
D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D019411:Clinical Laboratory Techniques; D004363:Drug Utilization; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009523:Newfoundland and Labrador; D010612:Pharyngitis / Q000188:drug therapy / Q000382:microbiology*; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000188:drug therapy*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents