scholarly journals Point-of-Care Testing for Pharyngitis in the Pharmacy

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 743
Author(s):  
Sabiha Essack ◽  
John Bell ◽  
Douglas Burgoyne ◽  
Wirat Tongrod ◽  
Martin Duerden ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Regional Differences ◽  
Point Of Care ◽  
Antibiotic Use ◽  
Community Pharmacies ◽  
Point Of Care Testing ◽  
Healthcare Settings ◽  
Group A ◽  
Limiting Condition ◽  
Opinion Article

Pharyngitis (also known as sore throat) is a common, predominately viral, self-limiting condition which can be symptomatically managed without antibiotic treatment. Inappropriate antibiotic use for pharyngitis contributes to the development and spread of antibiotic resistance. However, a small proportion of sore throats caused by group A streptococcal (GAS) infection may benefit from the provision of antibiotics. Establishing the cause of infection is therefore an important step in effective antibiotic stewardship. Point-of-care (POC) tests, where results are available within minutes, can distinguish between viral and GAS pharyngitis and can therefore guide treatment in primary healthcare settings such as community pharmacies, which are often the first point of contact with the healthcare system. In this opinion article, the evidence for the use of POC testing in the community pharmacy has been discussed. Evidence suggests that pharmacy POC testing can promote appropriate antibiotic use and reduce the need for general practitioner consultations. Challenges to implementation include cost, training and ‘who prescribes’, with country and regional differences presenting a particular issue. Despite these challenges, POC testing for pharyngitis has become widely available in pharmacies in some countries and may represent a strategy to contain antibiotic resistance and contribute to antimicrobial stewardship.

scholarly journals Group A Streptococcus Testing in Pediatrics: the Move to Point-of-Care Molecular Testing

2020 ◽  
Vol 58 (6) ◽  
Author(s):  
Thomas Z. Thompson ◽  
Allison R. McMullen
Keyword(s):  
Point Of Care ◽  
Streptococcal Pharyngitis ◽  
Molecular Methods ◽  
Multiple Point ◽  
Molecular Testing ◽  
Point Of Care Testing ◽  
Culture Methods ◽  
Content Type ◽  
Molecular Group ◽  
Group A

ABSTRACT Each year, there are an estimated 11 million visits to ambulatory care centers for pharyngitis in children between the ages of 3 and 18 years. While there are many causes of pediatric pharyngitis, group A streptococcal pharyngitis represents 15 to 30% of infections and is the only cause for which treatment is recommended. Unfortunately, clinical suspicion is insufficient for the accurate diagnosis of group A streptococcal pharyngitis, and laboratory testing for confirmation of Streptococcus pyogenes infection is required to prevent complications of infection. Traditionally, throat swabs are inoculated onto agar plates for isolation of the large-zone beta-hemolytic streptococcus. However, traditional culture methods present a potential delay in treatment due to turnaround times of 18 to 48 h. In order to improve turnaround times and enhance antimicrobial stewardship, multiple point-of-care assays have been developed. This review describes current point-of-care testing for group A streptococcal pharyngitis, including rapid antigen detection tests and more recent molecular methods. Additional attention is given to the diagnostic considerations when choosing a method for group A streptococcal point-of-care testing, implementation of molecular group A streptococcal testing, and the institutional cost of immunoassays compared to those of newer molecular methods.

scholarly journals 2796. The Impact of Syndromic Molecular Point-of-Care Testing for Respiratory Viruses on Antibiotic Use in Adults Presenting to Hospital with Exacerbation of Airways Disease: Further Analysis From a Randomized Controlled Trial

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S988-S988
Author(s):  
Tristan William Clark ◽  
Samuel Mills ◽  
Nathan Brendish
Keyword(s):  
Point Of Care ◽  
Survival Curve ◽  
Controlled Trial ◽  
Antibiotic Use ◽  
Respiratory Viruses ◽  
Influenza Viruses ◽  
Rank Test ◽  
Point Of Care Testing ◽  
Early Discontinuation ◽  
The Impact

Abstract Background The ResPOC study demonstrated that syndromic molecular point-of-care testing (POCT) for respiratory viruses was associated with earlier discontinuation of unnecessary antibiotics. Subgroup analysis suggests this occurs predominantly in patients with exacerbation of airways disease. Molecular POCT use is becoming widespread but there is a lack of evidence to inform the choice between multiplex syndromic panels vs. uniplex tests for influenza. Methods We evaluated patients with exacerbation of asthma or COPD who were treated with antibiotics. The duration of antibiotics and proportion with early discontinuation were compared between patients testing positive for viruses by POCT (FilmArray Respiratory Panel) those testing negative by POCT and controls. Patients testing positive for viruses by POCT were compared according to virus types detected. Survival curves were generated for duration of antibiotics and compared using the log-rank test. Results There were 118 patient with exacerbation of airways disease in the POCT group who received antibiotics and 111 in the controls. In the POCT group 49/118 (42%) patients tested positive for viruses. Of those testing positive for viruses by POCT 17/49 (35%) had early discontinuation of antibiotics vs. 9/81 (13%) in those testing negative and 7/111 (6%) in controls, P < 0.0001. Survival curve analysis showed a reduced time to antibiotic discontinuation in those testing positive for viruses, P = 0.034. Of those positive for viruses by POCT 20% were positive for influenza, 43% for rhinovirus and 37% for other viruses combined. The proportion with early discontinuation of antibiotics was not different between the virus types, P = 0.53. Conclusion Syndromic molecular POCT for viruses in adults with exacerbation of airways disease leads to early discontinuation in those positive for viruses. As most viruses detected were non-influenza viruses and there was no difference in antibiotic use between virus types, syndromic molecular POCT for respiratory viruses should be favored over uniplex POCT for influenza. Disclosures All authors: No reported disclosures.

Point-of-Care Testing for Group A Streptococcus Infection and Influenza

2017 ◽  
Vol 39 (19) ◽  
pp. 151-157 ◽  
Author(s):  
Jennifer Woo ◽  
Valerie Arboleda ◽  
Omai B. Garner
Keyword(s):  
Group A Streptococcus ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
Group A

scholarly journals Point of care testing for group A streptococci in patients presenting with pharyngitis will improve appropriate antibiotic prescription

2016 ◽  
Vol 28 (2) ◽  
pp. 199-204 ◽  
Author(s):  
Ulrich Orda ◽  
Biswadev Mitra ◽  
Sabine Orda ◽  
Mark Fitzgerald ◽  
Ronny Gunnarsson ◽  
...  
Keyword(s):  
Antibiotic Prescription ◽  
Point Of Care ◽  
Group A Streptococci ◽  
Point Of Care Testing ◽  
Group A

Preventing Medical Errors in Point-of-Care Testing

2001 ◽  
Vol 125 (10) ◽  
pp. 1307-1315 ◽  
Author(s):  
Gerald J. Kost
Keyword(s):  
Medical Errors ◽  
Information Exchange ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
Consensus Process ◽  
Process Step ◽  
Error Prevention ◽  
Group A ◽  
Emergency Systems ◽  
Group B

Abstract Objective.—To prevent medical errors, improve user performance, and enhance the quality, safety, and connectivity (bidirectional communication) of point-of-care testing. Participants.—Group A included 37 multidisciplinary experts in point-of-care testing programs in critical care and other hospital disciplines. Group B included 175 professional point-of-care managers, specialists, clinicians, and researchers. The total number of participants equaled 212. Evidence.—This study followed a systems approach. Expert specifications for prevention of medical errors were incorporated into the designs of security, validation, performance, and emergency systems. Additional safeguards need to be implemented through instrument software options and point-of-care coordinators. Connectivity will be facilitated by standards that eliminate deficiencies in instrument communication and device compatibility. Assessment of control features on handheld, portable, and transportable point-of-care instruments shows that current error reduction features lag behind needs. Consensus Process.—Step 1: United States national survey and collation of group A expert requirements for security, validation, and performance. Step 2: Design of parallel systems for these functions. Step 3: Written critique and improvement of the error-prevention systems during 4 successive presentations to group B participants over 9 months until system designs stabilized into final consensus form. Conclusions.—The consensus process produced 6 conclusions for preventing medical errors in point-of-care testing: (1) adopt operator certification and validation in point-of-care testing programs; (2) implement security, validation, performance, and emergency systems on existing and new devices; (3) require flexible, user-defined error-prevention system options on instruments as a prerequisite to federal licensing of new diagnostic tests and devices; (4) integrate connectivity standards for bidirectional information exchange; (5) preserve fast therapeutic turnaround time of point-of-care test results; and (6) monitor invalid use, operator competence, quality compliance, and other performance improvement indices to reduce errors, thereby focusing on patient outcomes. (Arch Pathol Lab Med. 2001;1307–1315)

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