title: Impact on antibiotic prescription of rapid antigen detection testing in acute pharyngitis in adults: a randomised clinical trial.
abstract: BACKGROUND
  Acute pharyngitis is one of the most frequent reasons for a GP consultation, and in most cases an antibiotic is prescribed.
  
  
  OBJECTIVE
  To determine the impact of rapid antigen detection testing (RADT) to identify group A beta haemolytic streptococcus in acute pharyngitis on the utilisation of antibiotics and appropriateness of their use.
  
  
  METHODS
  Cluster randomised controlled trial in primary care centres in Catalonia, Spain.
  
  
  METHODS
  Patients with acute pharyngitis aged 14 years or older with at least one Centor criterion (fever, tonsillar exudate, tender enlarged anterior cervical lymph nodes, or absence of cough) were recruited. Participant physicians were randomly assigned to one of two study arms: an intervention group (assigned to RADT) and a control group (following usual care, without RADT).
  
  
  RESULTS
  Of the 557 adults enrolled, 543 could be evaluated for analysis (281 [51.7%] in the intervention group and 262 [48.3%] in the control group). GPs without access to RADT were more likely to prescribe antibiotics compared with those who performed rapid tests (64.1% versus 43.8%, P<0.001). The more Centor criteria the patients presented, the greater the number of antibiotics prescribed, regardless of whether RADT was available (P<0.001). Antibiotics were prescribed in 30.7% of the cases with negative RADT results. Inappropriate antibiotic prescription was observed in 226 cases (43%), and was significantly greater in the control than in the intervention group (60% versus 26.9%; P<0.001).
  
  
  CONCLUSIONS
  Even though more than 30% of negative RADT results resulted in antibiotic prescribing, the study findings support the use of RADT in the consultation. This strategy has an important impact on reducing antibiotic prescription among adults with acute pharyngitis.
authors.affiliation: Primary Healthcare Centre Jaume I, Tarragona, University Rovira I Virgili, Spain. carles.llor@urv.cat
authors.forename: Carl
authors.initials: C
authors.lastname: Llor
authors.forename: Jordi
authors.initials: J
authors.lastname: Madurell
authors.forename: Montse
authors.initials: M
authors.lastname: Balagué-Corbella
authors.forename: Mónica
authors.initials: M
authors.lastname: Gómez
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Cots
mesh_terms: D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004812:Epidemiologic Methods; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests / Q000706:statistics & numerical data*; D010612:Pharyngitis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D013030:Spain / Q000453:epidemiology; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D013291:Streptococcus / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents