Antibiotic Stewardship Reflected by When to Test for Strep :

Does the presence of a sore throat automatically require a throat culture? Hopefully your answer is no, especially if your history and physical examination of a child suggest that the pharyngitis is likely due to a viral etiology.  While that may be the theoretical right thing to do, what happens in reality?  Shapiro et al. (10.1542/peds.2016-3403) have opted to look at the prevalence of viral signs and symptoms in children who did get rapid antigen detection tests (RADT) for group A strep (GAS) pharyngitis in an urban emergency department. They also studied the overall prevalence of GAS and sensitivity of the RADT in patients with and without viral indicators.  You may find their results difficult to swallow in that almost 2/3 of the children receiving RADT had at least one viral sign or symptom (e.g. cough, rhinorrhea, oral ulcers or conjunctival injection). GAS was much more prevalent in children with no viral features with the sensitivity of the RADT high and no different in patients with and without viral indicators.  What does all this mean?  It means that RADT testing should not be an automatic but a diagnostic testing strategy that is considered largely in patients with pharyngitis in the absence of viral signs and symptoms. For some, that may be a difficult strategy to carry out,  but this study will make all of us more aware of the need to be even better stewards of lab testing for GAS and in turn better stewards of automatic treatment with antibiotics for those who warrant such testing until cultures turn negative.  You won’t be sore about reading this interesting study on strep pharyngitis—so follow the link to it and learn more.