Sore throat clinical score boosts effective antibiotic use
By Kirsty Oswald, medwireNews Reporter
28 October 2013
BMJ 2013; 347: f5806

medwireNews: Research published in the BMJ shows that clinical score is as good a guide for antibiotic prescribing as rapid streptococcal antigen detection tests (RADTs) in patients presenting to primary care with sore throat.

The team, led by Paul Little from the University of Southampton, UK, says the findings suggest that use of clinical score can improve symptom resolution and enhance the targeted use of antibiotics.

They developed an internet program that randomly assigned patients (age ≥3 years) presenting to their general practitioner with sore throat to one of three groups: delayed antibiotic prescribing (control; n=168); clinical score (n=168); or RADTs (n=166).

In the control group, patients were told a prescription would be left in reception for them that they could collect after 3 to 5 days if symptoms did not improve. In the clinical score group, patients were given an immediate antibiotic if they scored at least 4 on the FeverPAIN clinical score or a delayed prescription if they scored 2 or 3. And, in the RADTs group, those with a FeverPAIN score of 3 or more underwent RADT testing and were given an immediate prescription if positive; those with a FeverPAIN score of 2 were given a delayed prescription.

The researchers found that patients in both the clinical score and RADTs groups experienced greater symptom improvement , the primary outcome of the study, by days 2 to 4 than patients in the control group. On a scale of 0–6, mean scores in these two groups were 2.88, and 2.83, respectively, versus 3.11 in the control group. However, they note that the change from baseline did not reach statistical or clinical significance in any group.

And, in the clinical score group, patients had significantly faster resolution of moderately bad symptoms compared with the control group, equivalent to experiencing 1 day less of such symptoms. Resolution of moderately bad symptoms was also faster, but not significantly so, in the RADTs group.

This improvement in symptom resolution was accompanied by a 29% lower rate of antibiotic use among patients in the clinical score group and a 27% lower rate of antibiotic use among patients in the RADTs group relative to the delayed prescription group .

“Our results suggest that across a range of practitioners and practices, use of either a simple clinical score or a clinical score with a rapid antigen test is likely to moderately improve symptom control and reduce antibiotic use,” comment Little and colleagues. However, they note that the addition of RADT offered “no clear advantages” compared with use of a clinical score alone.

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

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