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LETTERS: Morten Lindbaek Prescribing antibiotics for sore throats BMJ 1999; 318: 1138a [Full text]

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Antibiotics for sore throats. Potential of antigen detection tests II

Jurgen Steen Andersen, Niels Jerne Borrild   (5 July 1999)

Antibiotics for sore throats. Potential of antigen detection tests II 5 July 1999
Jurgen Steen Andersen, General Practice (NJB) Ringtoften 7, 2740 Skovlunde, Denmark, Niels Jerne Borrild Send response to journal: Re: Antibiotics for sore throats. Potential of antigen detection tests II	Professor Lindbaek calls for research on, how rapid tests influences prescribing patterns. Such research has been published in these columns only a few years ago (1). Out of 1327 Danish patients 390 (29%) had Group A Streptococcal throat infection on culture. The use of rapid strep testing led to an increase in the prescribing for patients with positive results on culture from 191 to 331, but to a decrease from 176 to 114 in the prescribing for patients negative on culture. Rapid testing for Group A Streptococcal throat infection thus increased prescribing of antibiotics, compared to diagnosis based on clinical diagnosis, due to the fact that in cases with controversy between clinical diagnosis and test result, positive tests where adhered to, whereas negative tests where only adhered to in half of the cases. The true value of tools for rapid diagnosis of disease should be measured in terms of their actual impact on the decision-making interface between clinicians and patients; how the does the test result influence (improve) the relevant clinical decision - whether or not to prescribe antibiotic treatment. The search continues for a rapid strep test that performs with high sensitivity in a population with a low-to-moderate probablity of having GABHS. But exploring factors that could improve GPs's ability to adhere to the results of rapid tests already available might prove to be just as efficient in terms of improving the rational prescribing of antibiotics for patients with clinical symptoms of GABHS infection. (1) TI: Antibiotics for sore throats. Potential of antigen detection tests [letter] AU: Andersen-JS; Borrild-NJ; Hoffmann-S SO: BMJ. 1995 Jan 7; 310(6971): 58-9