To read the full review go to Efficacy and safety of rapid tests to guide antibiotic prescriptions for sore throat

Plain language summary

Review question

Can rapid point-of-care tests help reduce antibiotic use in people with acute sore throat in primary care?

Background

Sore throat is one of the most common reasons for primary care visits. It can be caused by viruses or bacteria. The bacterial species most frequently identified in cases of sore throat is group A streptococcus (’strep throat’). Antibiotics are commonly prescribed for people with a sore throat, even though the majority of sore throats are caused by viruses, in which case antibiotics are ineffective and unnecessary. The concern is that antibiotics may cause side effects and contribute to antibiotic resistance, causing difficult-to-treat infections. It is particularly challenging for physicians to distinguish between sore throats of viral and bacterial origin by observation alone (clinically distinguish), even for experienced physicians. Throat swab cultures may take up to 48 hours to grow. This has led to the development of rapid tests. Several rapid tests are currently available to identify sore throat cases caused by group A streptococcus and can be used by doctors during primary care consultations for sore throat. These rapid tests could help reduce antibiotic prescriptions by withholding antibiotics in people with a negative test result. We assessed the available evidence from randomised controlled trials (a type of study in which participants are assigned to one of two or more treatment groups using a random method) to evaluate the effectiveness and safety of using rapid tests in primary care.

Study characteristics

We searched for randomised controlled trials published in any language up to June 2019. We identified five randomised controlled trials with a total of 2545 participants with sore throat in primary care settings.

Key results

Participants in the rapid test group were less likely to be prescribed antibiotics than participants managed based on clinical grounds (481/1197 versus 865/1348). A 25% reduction (i.e., a decrease of 25 percentage points) in antibiotic prescription rates is likely to be achieved by using rapid testing in people with sore throat in primary care. However, there may be little or no reduction between groups in dispensed antibiotic treatments. Antibiotic prescriptions refer to medicines prescribed by healthcare providers. Antibiotic dispensing refers to medicines accessed in pharmacies. In some cases, patients may not present to the pharmacy to get their prescription filled. Four trials reported data on the number of participants with a complication attributed to the initial infection (e.g., tonsil abscess): complications were rare (0 to 3 per trial), and there may be little or no difference between people managed on clinical grounds alone and those managed with rapid testing but the evidence is very uncertain.

Certainty of the evidence

We ranked the certainty of the evidence as moderate for the number of participants provided with an antibiotic prescription, low for the number of participants with an antibiotic dispensed, and very low for the number of participants with a complication attributed to the episode of sore throat (e.g., abscess of the tonsils), respectively.

Conclusion

Compared with usual decision-making based on clinical examination alone, implementing rapid tests can reduce antibiotic prescription rates, but may have little or no impact on antibiotic dispensing. More studies are needed to assess other outcomes that are important to patients, including safety.