Skip to main content
PMC home page
British Medical Journal (Clinical Research Ed.) logoLink to British Medical Journal (Clinical Research Ed.)
. 1988 Jun 11;296(6637):1646–1649. doi: 10.1136/bmj.296.6637.1646

Rational decisions in managing sore throat: evaluation of a rapid test

Peter Burke, John Bain, Andrew Lowes, Roger Athersuch
PMCID: PMC2546173  PMID: 3293699

Abstract

Sixty nine general practitioners recorded what they had prescribed for a total of 1189 episodes of sore throat. Antibiotics were prescribed in 763 (64%) episodes and broad spectrum antibiotics in 161 (21%) of these. If there was dysphagia, hoarseness, cervical adenopathy, and inflamed or purulent tonsils a prescription was more likely to be written. An enzyme immunoassay rapid test was evaluated as a means of rationalising prescribing. Among 23 general practitioners and 250 patients the sensitivity of the test was 63% and the specificity 91·7% compared with 74% and 58% for clinical assessment alone. Test results rarely caused previous prescribing decisions (155 (13%) episodes) to be altered.

We suggest that the time is not ripe for the use of the enzyme immunoassay rapid test on a wide scale in the routine assessment of sore throats.

Full text

PDF
1646

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Berkowitz C. D., Anthony B. F., Kaplan E. L., Wolinsky E., Bisno A. L. Cooperative study of latex agglutination to identify group A streptococcal antigen on throat swabs in patients with acute pharyngitis. J Pediatr. 1985 Jul;107(1):89–92. doi: 10.1016/s0022-3476(85)80621-1. [DOI] [PubMed] [Google Scholar]
  2. Breese B. B. A simple scorecard for the tentative diagnosis of streptococcal pharyngitis. Am J Dis Child. 1977 May;131(5):514–517. doi: 10.1001/archpedi.1977.02120180028003. [DOI] [PubMed] [Google Scholar]
  3. Chang M. J., Mohla C. Ten-minute detection of group A streptococci in pediatric throat swabs. J Clin Microbiol. 1985 Feb;21(2):258–259. doi: 10.1128/jcm.21.2.258-259.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fischer P. M., Mentrup P. L. Comparison of throat culture and latex agglutination test for streptococcal pharyngitis. J Fam Pract. 1986 Mar;22(3):245–248. [PubMed] [Google Scholar]
  5. Gerber M. A., Spadaccini L. J., Wright L. L., Deutsch L. Latex agglutination tests for rapid identification of group A streptococci directly from throat swabs. J Pediatr. 1984 Nov;105(5):702–705. doi: 10.1016/s0022-3476(84)80286-3. [DOI] [PubMed] [Google Scholar]
  6. Hjortdahl P., Laerum E., Gaustad P. How reliable and useful is the latex agglutination test in diagnosing streptococcal throat infection in general practice? Scand J Prim Health Care. 1987 Sep;5(3):151–154. doi: 10.3109/02813438709013996. [DOI] [PubMed] [Google Scholar]
  7. Howie J. G. A new look at respiratory illness in general practice. A reclassification of respiratory illness based on antibiotic prescribing. J R Coll Gen Pract. 1973 Dec;23(137):895–904. [PMC free article] [PubMed] [Google Scholar]
  8. Howie J. G., Bigg A. R. Family trends in psychotropic and antibiotic prescribing in general practice. Br Med J. 1980 Mar 22;280(6217):836–838. doi: 10.1136/bmj.280.6217.836. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Howie J. G., Foggo B. A. Antibiotics, sore throats and rheumatic fever. J R Coll Gen Pract. 1985 May;35(274):223–224. [PMC free article] [PubMed] [Google Scholar]
  10. Kaplan E. L., Bisno A., Derrick W., Facklam R., Gordis L., Houser H. B., Jackson W. H., Millard H. D., Shulman S. T., Taranta A. V. A.H.A. committee report. Prevention of rheumatic fever. Circulation. 1977 Jan;55(1 Suppl):1–4. [PubMed] [Google Scholar]
  11. Kellogg J. A., Manzella J. P. Detection of group A streptococci in the laboratory or physician's office. Culture vs antibody methods. JAMA. 1986 May 16;255(19):2638–2642. [PubMed] [Google Scholar]
  12. Komaroff A. L. A management strategy for sore throat. JAMA. 1978 Apr 3;239(14):1429–1432. [PubMed] [Google Scholar]
  13. Mäkelä M. Rapid throat-culture as diagnostic aid: ineffective in decreasing antibiotic prescriptions. Scand J Prim Health Care. 1987 Sep;5(3):145–150. doi: 10.3109/02813438709013995. [DOI] [PubMed] [Google Scholar]
  14. Otero J. R., Reyes S., Noriega A. R. Rapid diagnosis of group A streptococcal antigen extracted directly from swabs by an enzymatic procedure and used to detect pharyngitis. J Clin Microbiol. 1983 Aug;18(2):318–320. doi: 10.1128/jcm.18.2.318-320.1983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Platts P., Manson P. G., Finch R. Acute pharyngitis: a symptom scorecard and microbiological diagnosis. Br Med J (Clin Res Ed) 1982 Feb 6;284(6313):387–388. doi: 10.1136/bmj.284.6313.387. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Ross P. W. Antibiotic treatment of sore throat in Edinburgh children. Practitioner. 1972 Jul;209(249):47–52. [PubMed] [Google Scholar]
  17. Schwabe L. D., Small M. T., Randall E. L. Comparison of TestPack Strep A test kit with culture technique for detection of group A streptococci. J Clin Microbiol. 1987 Feb;25(2):309–311. doi: 10.1128/jcm.25.2.309-311.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Taylor J. L., Howie J. G. Antibiotics, sore throats and acute nephritis. J R Coll Gen Pract. 1983 Dec;33(257):783–786. [PMC free article] [PubMed] [Google Scholar]
  19. True B. L., Carter B. L., Driscoll C. E., House J. D. Effect of a rapid diagnostic method on prescribing patterns and ordering of throat cultures for streptococcal pharyngitis. J Fam Pract. 1986 Sep;23(3):215–219. [PubMed] [Google Scholar]
  20. Veasy L. G., Wiedmeier S. E., Orsmond G. S., Ruttenberg H. D., Boucek M. M., Roth S. J., Tait V. F., Thompson J. A., Daly J. A., Kaplan E. L. Resurgence of acute rheumatic fever in the intermountain area of the United States. N Engl J Med. 1987 Feb 19;316(8):421–427. doi: 10.1056/NEJM198702193160801. [DOI] [PubMed] [Google Scholar]
  21. Wolinsky E., Adams W. Diagnosis of streptococcal pharyngitis by rapid antigen detection from the throat swab. J Fam Pract. 1986 Mar;22(3):277-8, 280. [PubMed] [Google Scholar]

Articles from British Medical Journal (Clinical research ed.) are provided here courtesy of BMJ Publishing Group

RESOURCES