Observational studyJournal of general internal medicine2013
Management of adults with acute streptococcal pharyngitis: minimal value for backup strep testing and overuse of antibiotics.
Observational study in Journal of general internal medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
12 citing papers in PubMed, 31 citations in OpenAlex.
- Modalities of group A streptococcal prevention and treatment and their economic justification.NPJ vaccines · 2023Article
- The Impact of Point-of-Care Polymerase Chain Reaction Testing on Prescribing Practices in Primary Care for Management of Strep A: A Retrospective Before-After Study.Open forum infectious diseases · 2022Article
- Pharyngitis: Approach to diagnosis and treatment.Canadian family physician Medecin de famille canadien · 2020Review
- Review
- Diagnostic Methods, Clinical Guidelines, and Antibiotic Treatment for Group A Streptococcal Pharyngitis: A Narrative Review.Frontiers in cellular and infection microbiology · 2020Review
- Diagnosis and Management of Group a Streptococcal Pharyngitis in the United States, 2011-2015.BMC infectious diseases · 2019Article
- Peritonsillar abscess (PTA): clinical characteristics, microbiology, drug exposures and outcomes of a large multicenter cohort survey of 412 patients hospitalized in 13 French university hospitals.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2016Article
- Usefulness of Leukocyte Esterase Test Versus Rapid Strep Test for Diagnosis of Acute Strep Pharyngitis.Global pediatric health · 2015Article
- Pharyngitis.Primary care · 2014Review
- An initiative to improve adherence to evidence-based guidelines in the treatment of URIs, sinusitis, and pharyngitis.Journal of community hospital internal medicine perspectives · 2014Article
- Participatory medicine: A home score for streptococcal pharyngitis enabled by real-time biosurveillance: a cohort study.Annals of internal medicine · 2013Article
- Shifting the paradigm for promoting appropriate antibiotic use.Journal of general internal medicine · 2013Article
Corrections and comments
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Authors and funding
2 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundRapid antigen detection tests (RADT) are commonly used to guide appropriate antibiotic treatment of group A beta-hemolytic streptococcal (GABHS) pharyngitis. In adults, there is controversy about the need for routine backup testing of negative RADT.
objectiveEstimate the costs and benefits in adults of routine backup testing by DNA Gen-probe of negative RADT (Acceava).
designObservational follow-up study.
participantsAll patients aged 18 years and older visiting a Cleveland Clinic generalist physician in 2009 and 2010 with a visit diagnosis of acute pharyngitis (ICD codes 462, 034.0). MAIN MEASURES: The patients were identified using the Cleveland Clinic Epic Clarity database. We determined the proportion of false negative RADT, antibiotic prescription patterns and rate of serious suppurative complications within 30 days of the office visit. KEY
resultsOf 25,130 patients with acute pharyngitis, 19% had no testing and 81% were tested. Of the 15,555 patients that had a negative RADT and follow-up DNA probe, 6% had a positive DNA probe. Of the 953 patients who had a negative RADT and a positive DNA strep probe, 48% received an antibiotic prescription at the time of the visit and 51% received an antibiotic prescription after an average of 2.3 days. Only one patient with a negative RADT and no follow-up DNA probe developed a peritonsillar abscess. Overall, of the 15,555 DNA probes performed, management was altered in only 3% of the patients at a total cost of $1,757,715. Fifty-six percent received an antibiotic while only 19.5% had a confirmed strep throat diagnosis.
conclusionsThe false negative rate of Acceava RADT for the diagnosis of GABHS pharyngitis was 6%. We question the benefit of routine DNA probe backup testing in adults because of its substantial cost, an average delay in antibiotic prescribing of over 2 days, and because suppurative complications are very uncommon. We found a high rate of inappropriate antibiotic prescribing.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.