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Treating Acute Pharyngitis in Adults

A rapid streptococcal antigen test enabled researchers to maximize appropriate antibiotic use cost-effectively.

Acute pharyngitis in adults is principally caused by viruses, but 10% of cases are bacterial, and most of these are attributable to group A ß-hemolytic streptococci (GAS). Antibiotics are generally reserved for individuals believed to have GAS. In this study, researchers identified the most efficient of five approaches to determining which patients require antibiotic therapy. A total of 372 adults with at least two of four clinical characteristics (temperature 38°C, tonsillar exudates, tender cervical adenopathy, and no cough or rhinitis) were enrolled in the study and underwent a throat culture and rapid streptococcal antigen test (RSAT).

Approximately 69% of patients had tonsillar exudates, and 74% had painful lymph nodes. The prevalence of GAS based on throat culture was 38%. Compared with throat culture, the gold standard for determining need for antibiotics, a strategy of empirical antibiotic treatment of patients with three or four clinical findings led to antibiotic overuse in 32% of all patients and underuse in 9%. Testing all patients with RSAT and treating only positive patients led to antibiotic overuse in 3% of all patients and to underuse in 3%. Testing all patients with RSAT was also the most cost-effective strategy.

Comment: In this study of acute pharyngitis in adults, a strategy of testing all patients who had at least two of four high-risk characteristics with a rapid streptococcal antigen test and treating only positive cases maximized appropriate antibiotic use and cost-effectiveness.

— Jamaluddin Moloo, MD, MPH

Published in Journal Watch General Medicine April 11, 2006

Citation(s):

Humair J-P et al. Management of acute pharyngitis in adults: Reliability of rapid streptococcal tests and clinical findings. Arch Intern Med 2006 Mar 27; 166:640-4.

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