Introduction: Acute pharyngitis is a common reason for primary care or emergency department visits, often resulting in antibiotic prescription. Rapid antigen detection tests (RADT) are routinely used to diagnose Group A Streptococcus (GAS) pharyngitis. However, due to its low sensitivity, patient pressures and conflicting guidelines, the RADT often complicates management decisions. Our aim was to assess the impact of RADT in patients presenting with acute GAS pharyngitis on the antibiotic prescription rate and appropriateness of antibiotic management. Methods: We systematically searched Medline, Embase, and Cochrane databases from 1980 to June 2016. Studies were selected according to a predefined PRISMA protocol and data extracted by two independent reviewers. Prospective and retrospective studies that evaluated the impact of RADT on antibiotic prescription for pharyngitis were included. Study quality was assessed using Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. Our main outcome was a dichotomous measure of antibiotic prescription, with or without RADT availability. Studies were combined if there was low clinical and statistical heterogeneity (I2<30%). Bivariate Mantel-Haenszel random effects model was used to perform meta analyses using SPSS 22 and Revman 5. Results: We identified 4003 studies: 139 were selected for full text review; 10 met our inclusion criteria (N=10859 participants, median age 31 years, 56.7% female). Mean antibiotic prescription rate in the RADT and control arm was 38.2% (SD 15.6) and 55.9% (SD 16.3), respectively. The use of RADT was associated with lower antibiotic prescription rate in both adults (OR=0.60 [95% CI 0.45-0.80], I2=8%, N=1407) and pediatrics (OR=0.49 [95% CI 0.44-0.55], I2=5%, N=976). There was no overall difference (p<0.3) in antibiotic prescription rate among disease severity (Centor scores 1-4). The use of RADT did not significantly impact the appropriateness of antibiotic management (OR=1.15 95% CI 0.94-1.5). Conclusion: The use of RADT is associated with a reduction in antibiotic prescription for patients with GAS pharyngitis without an increase in appropriate antibiotic use. Despite low prevalence of the disease in the population, antibiotic prescription rates are still high. These findings suggest great potential for antibiotic stewardship and reevaluation of current guidelines for managing GAS pharyngitis.
The Effect of Rapid Antigen Detection Test on Antibiotic Prescription Decision of Clinicians and Reducing Antibiotic Costs in Children with Acute Pharyngitis
