title: Diagnosing streptococcal sore throat in adults: randomized controlled trial of in-office aids.
abstract: 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.
authors.affiliation: Memorial University of Newfoundland, St John's. gworrall@mun.ca
authors.forename: Graham
authors.initials: G
authors.lastname: Worrall
authors.forename: James
authors.initials: J
authors.lastname: Hutchinson
authors.forename: Gregory
authors.initials: G
authors.lastname: Sherman
authors.forename: Joseph
authors.initials: J
authors.lastname: Griffiths
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents