Trial reportBMJ (Clinical research ed.)2013
Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management).
Trial report in BMJ (Clinical research ed.), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 82 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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
82 citing papers in PubMed, 6 syntheses or guidelines pooled it, 157 citations in OpenAlex.
- Pooled it
- Predictors of rheumatic fever in sore throat patients: a systematic review and meta-analysis.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2022Pooled it
- Clinical Practice Guideline: Sore Throat.Deutsches Arzteblatt international · 2021Guideline
- Efficacy and safety of rapid tests to guide antibiotic prescriptions for sore throat.The Cochrane database of systematic reviews · 2020Pooled it
- Rapid antigen detection and molecular tests for group A streptococcal infections for acute sore throat: systematic reviews and economic evaluation.Health technology assessment (Winchester, England) · 2020Pooled it
- Impact analysis studies of clinical prediction rules relevant to primary care: a systematic review.BMJ open · 2016Pooled it
- Influence of a guideline or an additional rapid strep test on antibiotic prescriptions for sore throat: the cluster randomized controlled trial of HALS (Hals und Antibiotika Leitlinien Strategien).BMC primary care · 2023Trial
- Antibiotic effectiveness for children with lower respiratory infections: prospective cohort and trial in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2023Trial
- Clinical course of pharyngotonsillitis with group A streptococcus treated with different penicillin V strategies, divided in groups of Centor Score 3 and 4: a prospective study in primary care.BMC infectious diseases · 2022Trial
- Prevalence of Group AThe American journal of tropical medicine and hygiene · 2020Trial
- Effects of primary care antimicrobial stewardship outreach on antibiotic use by general practice staff: pragmatic randomized controlled trial of the TARGET antibiotics workshop.The Journal of antimicrobial chemotherapy · 2018Trial
- Trial
- General Practitioner Antimicrobial Stewardship Programme Study (GAPS): protocol for a cluster randomised controlled trial.BMC family practice · 2016Trial
- Amoxicillin for acute lower respiratory tract infection in primary care: subgroup analysis of potential high-risk groups.The British journal of general practice : the journal of the Royal College of General Practitioners · 2014Trial
- An overview of CRISPR-artificial intelligence theranostics: Current and emerging applications.Biomaterials translational · 2026Review
- The Impact of Point-of-Care Testing for Group A Streptococcal Pharyngitis on Antibiotic Prescribing and Patient Health Outcomes in Outpatient Care: A Systematic Review and Meta-analysis of Randomized Controlled Trials.Open forum infectious diseases · 2025Article
- Development of the CRISPR-Cas12a-Based Biosensing System for Rapid, Ultrasensitive, and Highly Specific Detection ofACS omega · 2025Article
- Use of point-of-care tests in pharyngotonsillitis - a registry-based study in primary health care.Scandinavian journal of primary health care · 2025Article
- The burden of group AiScience · 2025Review
- Comparison of Group A Streptococcus Antigen Detection and Pathogen Culture in Paediatric Infections.Infection and drug resistance · 2025Article
22 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
- Erratum issued
Authors and funding
14 authors at 5 institutions in 2 countries.
Funding
Abstract
objectiveTo determine the effect of clinical scores that predict streptococcal infection or rapid streptococcal antigen detection tests compared with delayed antibiotic prescribing.
designOpen adaptive pragmatic parallel group randomised controlled trial.
settingPrimary care in United Kingdom. PATIENTS: Patients aged ≥ 3 with acute sore throat.
interventionAn internet programme randomised patients to targeted antibiotic use according to: delayed antibiotics (the comparator group for analyses), clinical score, or antigen test used according to clinical score. During the trial a preliminary streptococcal score (score 1, n=1129) was replaced by a more consistent score (score 2, n=631; features: fever during previous 24 hours; purulence; attends rapidly (within three days after onset of symptoms); inflamed tonsils; no cough/coryza (acronym FeverPAIN). OUTCOMES: Symptom severity reported by patients on a 7 point Likert scale (mean severity of sore throat/difficulty swallowing for days two to four after the consultation (primary outcome)), duration of symptoms, use of antibiotics.
resultsFor score 1 there were no significant differences between groups. For score 2, symptom severity was documented in 80% (168/207 (81%) in delayed antibiotics group; 168/211 (80%) in clinical score group; 166/213 (78%) in antigen test group). Reported severity of symptoms was lower in the clinical score group (-0.33, 95% confidence interval -0.64 to -0.02; P=0.04), equivalent to one in three rating sore throat a slight versus moderate problem, with a similar reduction for the antigen test group (-0.30, -0.61 to -0.00; P=0.05). Symptoms rated moderately bad or worse resolved significantly faster in the clinical score group (hazard ratio 1.30, 95% confidence interval 1.03 to 1.63) but not the antigen test group (1.11, 0.88 to 1.40). In the delayed antibiotics group, 75/164 (46%) used antibiotics. Use of antibiotics in the clinical score group (60/161) was 29% lower (adjusted risk ratio 0.71, 95% confidence interval 0.50 to 0.95; P=0.02) and in the antigen test group (58/164) was 27% lower (0.73, 0.52 to 0.98; P=0.03). There were no significant differences in complications or reconsultations.
conclusionTargeted use of antibiotics for acute sore throat with a clinical score improves reported symptoms and reduces antibiotic use. Antigen tests used according to a clinical score provide similar benefits but with no clear advantages over a clinical score alone.
trial registrationISRCTN32027234.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.