Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 Jun 4;6(6):CD012431.
doi: 10.1002/14651858.CD012431.pub2.

Efficacy and safety of rapid tests to guide antibiotic prescriptions for sore throat

Jérémie F Cohen  1   2 , Jean-Yves Pauchard  3 , Nils Hjelm  4 , Robert Cohen  5 , Martin Chalumeau  1   2
Affiliations
Meta-Analysis

Efficacy and safety of rapid tests to guide antibiotic prescriptions for sore throat

Jérémie F Cohen et al. Cochrane Database Syst Rev. .

Abstract

Background: Sore throat is a common condition caused by viruses or bacteria, and is a leading cause of antibiotic prescription in primary care. The most common bacterial species is group A streptococcus ('strep throat'). Between 50% to 70% of pharyngitis cases are treated with antibiotics, despite the majority of cases being viral in origin. One strategy to reduce antibiotics is to use rapid tests for group A streptococcus to guide antibiotic prescriptions. Rapid tests can be used alone or in combination with a clinical scoring system.

Objectives: To assess the efficacy and safety of strategies based on rapid tests to guide antibiotic prescriptions for sore throat in primary care settings.

Search methods: We searched CENTRAL, MEDLINE, Embase, CINAHL, Web of Science, and LILACS, as well as the trial registries ClinicalTrials.gov and the WHO ICTRP on 5 June 2019.

Selection criteria: We included randomised controlled trials (RCTs) comparing rapid tests with management based on clinical grounds to guide the prescription of antibiotics for people with a sore throat in ambulatory care settings. We included trials that randomised individuals, as well as cluster-RCTs in which individual practitioners (or practices) or emergency departments were randomised.

Data collection and analysis: Two review authors independently extracted data on the primary outcomes (number of participants provided with an antibiotic prescription; number of participants with an antibiotic dispensed) and secondary outcomes (duration of sore throat symptoms; duration of other symptoms; quality of life measures; number of participants with a complication attributed to the index infection; number of participants in need of re-consultation by the end of follow-up; number of participants in need of hospital admission by the end of follow-up; number of satisfied participants; number of participants with an adverse event attributed to the rapid test). We assessed the risk of bias of all included trials and used GRADE to assess the certainty of the evidence. We performed meta-analyses and sensitivity analyses when feasible.

Main results: We included five trials (2891 children and adult participants in total; 2545 participants after adjusting for clustering). Management in the intervention group was as follows: in three trials rapid tests were used in combination with a clinical scoring system; in one trial, some physicians were asked to use rapid tests alone, while others were asked to use rapid tests in combination with a clinical scoring system; in one trial, rapid tests were used alone. Based on data from five trials (2545 participants), a large reduction in prescribed antibiotics was found in the rapid test group (481/1197) versus management based on clinical grounds (865/1348), for a summary risk difference (RD) of -25%, 95% confidence interval (CI) -31% to -18%; I2 = 62%; moderate-certainty evidence. Estimates of effect on antibiotic prescription rates were stable in various sensitivity analyses. Based on data from two trials (900 people) originating from the same overarching study, the evidence suggests that rapid tests may not reduce dispensed antibiotic treatments: rapid test group (156/445) versus management based on clinical grounds (197/455); summary RD -7%, 95% CI -17% to 2%; I2 = 53%; low-certainty evidence. Four trials (2075 participants) reported data on the number of participants with a complication attributed to the index infection; the summary odds ratio (OR) was 0.85, 95% CI 0.03 to 26.65; P = 0.93; I2 = 62%; very low-certainty evidence, which means that people in the rapid testing group were less likely to develop complications of the index infection, but the evidence is very uncertain. Two trials (1161 participants) reported on the number of participants in need of re-consultation by the end of follow-up; the summary OR was 1.12, 95% CI 0.57 to 2.21; P = 0.74; I2 = 59%; low-certainty evidence, which means that participants in the rapid testing group were more likely to be in need of re-consultation by the end of the study follow-up, but the evidence is uncertain. Lack of data impeded assessment of other secondary outcomes (including safety outcomes) and of sources of heterogeneity. AUTHORS' CONCLUSIONS: Rapid testing to guide antibiotic treatment for sore throat in primary care probably reduces antibiotic prescription rates by 25% (absolute risk difference), but may have little or no impact on antibiotic dispensing. More studies are needed to assess the efficacy and safety of rapid test-guided antibiotic prescribing, notably to evaluate patient-centred outcomes and variability across subgroups (e.g. adults versus children).

PubMed Disclaimer

Conflict of interest statement

  1. Jérémie F Cohen: None known.

  2. Jean‐Yves Pauchard: None known.

  3. Nils Hjelm: I have received three scholarships (one scholarship for conducting research abroad as part of my medical studies at the Lund University; one scholarship for conducting research in France; and one scholarship from the Erasmus Funding Programme for conducting research in another European Union country). None of the received scholarships are regarded as potential conflicts of interest.

  4. Robert Cohen: RC’s institution, ACTIV, has received research grant support from Pfizer, GlaxoSmithKline, Merck, and Sanofi Pasteur MSD. RC reports personal fees from Pfizer, GlaxoSmithKline, Merck, Sanofi, and AstraZeneca, outside the submitted work. These potential interests are only in the field of vaccines.

  5. Martin Chalumeau: No financial competing interest in relation to the present systematic review.

  6. JFC, RC, and MC have conducted diagnostic accuracy studies about rapid tests for strep throat in which rapid tests kits were provided by the manufacturer (Dectrapharm/Biosynex). These studies were not in the scope of the present review and thus were not included in the review.

Figures

1
1
Type of interventions: Rapid tests can be used alone or in combination with a clinical scoring system.
2
2
Study flow diagram.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Comparison 1: Rapid test (with and without scoring system combined) versus clinical grounds (with and without scoring system combined), outcome: 1.1 Number of participants provided with an antibiotic prescription.
5
5
Comparison 1: Rapid test (with and without scoring system combined) versus clinical grounds (with and without scoring system combined), outcome: 1.2 Number of participants with an antibiotic dispensed.
6
6
Comparison 1: Rapid test (with and without scoring system combined) versus clinical grounds (with and without scoring system combined), outcome: 1.6 Number of participants with a complication attributed to the index infection.
1.1
1.1. Analysis
Comparison 1: Comparison 1: Rapid test (with and without scoring system combined) versus clinical grounds (with and without scoring system combined), Outcome 1: Number of participants provided with an antibiotic prescription
1.2
1.2. Analysis
Comparison 1: Comparison 1: Rapid test (with and without scoring system combined) versus clinical grounds (with and without scoring system combined), Outcome 2: Number of participants with an antibiotic dispensed
1.3
1.3. Analysis
Comparison 1: Comparison 1: Rapid test (with and without scoring system combined) versus clinical grounds (with and without scoring system combined), Outcome 3: Number of participants with a complication attributed to the index infection
1.4
1.4. Analysis
Comparison 1: Comparison 1: Rapid test (with and without scoring system combined) versus clinical grounds (with and without scoring system combined), Outcome 4: Number of participants in need of re‐consultation by the end of follow‐up
2.1
2.1. Analysis
Comparison 2: Comparison 2: Rapid test alone versus clinical grounds (with scoring system), Outcome 1: Number of participants provided with an antibiotic prescription
3.1
3.1. Analysis
Comparison 3: Comparison 3: Rapid test alone versus clinical grounds (without scoring system), Outcome 1: Number of participants provided with an antibiotic prescription
4.1
4.1. Analysis
Comparison 4: Comparison 4: Rapid test used with a scoring system versus clinical grounds (with scoring system), Outcome 1: Number of participants provided with an antibiotic prescription
4.2
4.2. Analysis
Comparison 4: Comparison 4: Rapid test used with a scoring system versus clinical grounds (with scoring system), Outcome 2: Number of participants with an antibiotic dispensed
5.1
5.1. Analysis
Comparison 5: Comparison 5: Rapid test used with a scoring system versus clinical grounds (without scoring system), Outcome 1: Number of participants provided with an antibiotic prescription
6.1
6.1. Analysis
Comparison 6: Sensitivity analysis: studies at low risk of bias, Outcome 1: Sensitivity analysis: studies at low risk of bias
7.1
7.1. Analysis
Comparison 7: Sensitivity analysis: Studies with individual randomisation, Outcome 1: Sensitivity analysis: Studies with individual randomisation
8.1
8.1. Analysis
Comparison 8: Sensitivity analysis: Missing data as failures, Outcome 1: Number of participants provided with an antibiotic
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD012431

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Little 2013a {published data only}
    1. Little P, Hobbs FD, Moore M, Mant D, Williamson I, McNulty C, et al. Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management). BMJ 2013;347:f5806. - PMC - PubMed
Little 2013b {published data only}
    1. Little P, Hobbs FD, Moore M, Mant D, Williamson I, McNulty C, et al. Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management). BMJ 2013;347:f5806. - PMC - PubMed
Llor 2011a {published data only}
    1. Llor C, Madurell J, Balagué-Corbella M, Gómez M, Cots JM. Impact on antibiotic prescription of rapid antigen detection testing in acute pharyngitis in adults: a randomised clinical trial. British Journal of General Practice 2011;61:e244-51. - PMC - PubMed
Maltezou 2008 {published data only}
    1. Maltezou HC, Tsagris V, Antoniadou A, Galani L, Douros C, Katsarolis I, et al. Evaluation of a rapid antigen detection test in the diagnosis of streptococcal pharyngitis in children and its impact on antibiotic prescription. Journal of Antimicrobial Chemotherapy 2008;62:1407–12. - PubMed
Worrall 2007a {published data only}
    1. Worrall G, Hutchinson J, Sherman G, Griffiths J. Diagnosing streptococcal sore throat in adults: randomized controlled trial of in-office aids. Canadian Family Physician 2007;53:666-71. - PMC - PubMed

References to studies excluded from this review

Al‐Najjar 2008 {published data only}
    1. Al-Najjar FY, Uduman SA. Clinical utility of a new rapid test for the detection of group A Streptococcus and discriminate use of antibiotics for bacterial pharyngitis in an outpatient setting. International Journal of Infectious Diseases 2008;12:308-11. - PubMed
Alper 2013 {published data only}
    1. Alper Z, Uncu Y, Akalin H, Ercan I, Sinirtas M, Bilgel NG. Diagnosis of acute tonsillopharyngitis in primary care: a new approach for low-resource settings. Journal of Chemotherapy 2013;25:148-55. - PubMed
Bird 2018 {published data only}
    1. Bird C, Winzor G, Lemon K, Moffat A, Newton T, Gray J. A pragmatic study to evaluate the use of a rapid diagnostic test to detect group A streptococcal pharyngitis in children with the aim of reducing antibiotic use in a UK emergency department. Pediatric Emergency Care 2018 Jul 24 [Epub ahead of print]. [DOI: 10.1097/PEC.0000000000001560] - DOI - PubMed
Bottaro 2007 {published data only}
    1. Bottaro G, Morselli I. Epidemiology and clinical pictures of pharyngitis: report on the activity of a family paediatrician. Pediatria Medica e Chirurgica 2007;29:326-30. - PubMed
Buchbinder 2007 {published data only}
    1. Buchbinder N, Benzdira A, Belgaid A, Dufour D, Paon JC, Morel A, et al. Streptococcal pharyngitis in the pediatric emergency department: value and impact of rapid antigen detection test. Archives de Pédiatrie 2007;14:1057-61. - PubMed
Cardoso 2013 {published data only}
    1. Cardoso DM, Gilio AE, Hsin SH, Machado BM, Paulis M, Lotufo JP, et al. Impact of the rapid antigen detection test in diagnosis and treatment of acute pharyngotonsillitis in a pediatric emergency room. Revista Paulista de Pediatria 2013;31:4-9. - PubMed
Cohen 2017 {published data only}
    1. Cohen R, Haas H, Lorrot M, Biscardi S, Romain O, Vie Le Sage F, et al. Antimicrobial treatment of ENT infections. Archives de Pédiatrie 2017;24:S9-16. - PubMed
Contessotto 2000 {published data only}
    1. Contessotto Spadetto C, Camara Simon M, Aviles Ingles MJ, Ojeda Escuriet JM, Cascales Barcelo I, Rodriguez Sanchez F. Rational use of antibiotics in pediatrics: impact of a rapid test for detection of beta-haemolytic group A streptococci in acute pharyngotonsillitis. Anales Espanoles de Pediatria 2000;52:212-9. - PubMed
Dodd 2018 {published data only}
    1. Dodd M, Adolphe A, Parada A, Brett M, Culbreath K, Mercier RC. Clinical impact of a rapid streptococcal antigen test on antibiotic use in adult patients. Diagnostic Microbiology and Infectious Disease 2018;91:339-44. - PubMed
Frost 2019 {published data only}
    1. Frost HM, Fritsche TR, Hall MC. Beta-hemolytic nongroup A streptococcal pharyngitis in children. Journal of Pediatrics 2019;206:268-73.e1. - PubMed
Harris 1995 {published data only}
    1. Harris R, Paine D, Wittler R, Bruhn F. Impact on empiric treatment of group A streptococcal pharyngitis using an optical immunoassay. Clinical Pediatrics 1995;34:122-7. - PubMed
Hedges 1991 {published data only}
    1. Hedges JR, Singal BM, Estep JL. The impact of a rapid screen for streptococcal pharyngitis on clinical decision making in the emergency department. Medical Decision Making 1991;11:119-24. - PubMed
Humair 2006 {published data only}
    1. Humair JP, Revaz SA, Bovier P, Stalder H. Management of acute pharyngitis in adults: reliability of rapid streptococcal tests and clinical findings. Archives of Internal Medicine 2006;166:640-4. - PubMed
Lieu 1986 {published data only}
    1. Lieu TA, Fleisher GR, Schwartz JS. Clinical performance and effect on treatment rates of latex agglutination testing for streptococcal pharyngitis in an emergency department. Pediatric Infectious Disease 1986;5:655-9. - PubMed
Little 2014a {published data only}
    1. Little P, Moore M, Hobbs FD, Mant D, McNulty C, Williamson I, et al. Randomised controlled trial of a clinical score and rapid antigen detection test for sore throats. Health Technology Assessment 2014;18:29-39.
Little 2014b {published data only}
    1. Little P, Hobbs FD, Moore M, Mant D, Williamson I, McNulty C, et al. PRImary care Streptococcal Management (PRISM) study: in vitro study, diagnostic cohorts and a pragmatic adaptive randomised controlled trial with nested qualitative study and cost-effectiveness study. Health Technology Assessment 2014;18:vii-xxv, 1. - PMC - PubMed
Llor 2011b {published data only}
    1. Llor C, Cots JM, Gonzalez Lopez-Valcarcel B, Dios Alcantara J, Garcia G, Arranz J, et al. Effect of two interventions on reducing antibiotic prescription in pharyngitis in primary care. Journal of Antimicrobial Chemotherapy 2011;66:210-5. - PubMed
Llor 2014a {published data only}
    1. Llor C, Cots JM, Hernández S, Ortega J, Arranz J, Monedero MJ, et al. Effectiveness of two types of intervention on antibiotic prescribing in respiratory tract infections in primary care in Spain: Happy Audit Study. Atencion Primaria 2014;46:492-500. - PMC - PubMed
Llor 2014b {published data only}
    1. Llor C, Bjerrum L, Munck A, Cots JM, Hernández S, Moragas A. Access to point-of-care tests reduces the prescription of antibiotics among antibiotic-requesting subjects with respiratory tract infections. Respiratory Care 2014;59:1918-23. - PubMed
Llor 2018 {published data only}
    1. Llor C, Bjerrum L, Molero JM, Moragas A, González López-Valcárcel B, Monedero MJ, et al. Long-term effect of a practice-based intervention (HAPPY AUDIT) aimed at reducing antibiotic prescribing in patients with respiratory tract infections. Journal of Antimicrobial Chemotherapy 2018;73:2215-22. - PubMed
Llor 2019 {published data only}
    1. Llor C, Molero JM, Moragas A, Cordoba G, Bjerrum L. Use of point-of-care tests and antibiotic prescribing in sore throat and lower respiratory infections by general practitioners. Enfermedades Infecciosas y Microbiología Clínica 2019;38:21-4. [DOI: 10.1016/j.eimc.2019.02.005] - DOI - PubMed
Luo 2019 {published data only}
    1. Luo R, Sickler J, Vahidnia F, Lee YC, Frogner B, Thompson M. Diagnosis and management of group A streptococcal pharyngitis in the United States, 2011-2015. BMC Infectious Diseases 2019;19:193. - PMC - PubMed
Madurell 2010 {published data only}
    1. Madurell J, Balague M, Gomez M, Cots JM, Llor C. Impact of rapid antigen detection testing on antibiotic prescription in acute pharyngitis in adults. FARINGOCAT STUDY: a multicentric randomized controlled trial. BMC Family Practice 2010;11:25. - PMC - PubMed
Maizia 2012 {published data only}
    1. Maizia A, Letrilliart L, Colin C. Diagnostic strategies for acute tonsillitis in France: a cost-effectiveness study. Presse Medicale 2012;41:e195-203. - PubMed
Majeed 1993 {published data only}
    1. Majeed HA, al-Doussary L, Moussa MM, Yusuf AR, Suliman AH. Office diagnosis and management of group A streptococcal pharyngitis employing the rapid antigen detecting test. A 1-year prospective study of reliability and cost in primary care centres. Annals of Tropical Paediatrics 1993;13:65-72. - PubMed
Makela 1989 {published data only}
    1. Makela M. Effect of latex agglutination test on prescribing for group A streptococcal throat disease in primary care. Scandinavian Journal of Infectious Diseases 1989;21:161-7. - PubMed
McGinn 2013 {published data only}
    1. McGinn TG, McCullagh L, Kannry J, Knaus M, Sofianou A, Wisnivesky JP, et al. Efficacy of an evidence-based clinical decision support in primary care practices: a randomized clinical trial. JAMA Internal Medicine 2013;173:1584-91. - PubMed
McIsaac 2004 {published data only}
    1. McIsaac WJ, Kellner JD, Aufricht P, Vanjaka A, Low DE. Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA 2004;291:1587-95. - PubMed
NCT03744832 {published data only}
    1. NCT03744832. Point of care streptococcal pharyngitis testing. clinicaltrials.gov/ct2/show/NCT03744832 (first posted 16 November 16 2018).
Orda 2016 {published data only}
    1. Orda U, Mitra B, Orda S, Fitzgerald M, Gunnarsson R, Rofe G, et al. Point of care testing for group A streptococci in patients presenting with pharyngitis will improve appropriate antibiotic prescription. Emergency Medicine Australasia 2016;28:199-204. - PubMed
Papastergiou 2018 {published data only}
    1. Papastergiou J, Trieu CR, Saltmarche D, Diamantouros A. Community pharmacist-directed point-of-care group A Streptococcus testing: evaluation of a Canadian program. Journal of the American Pharmacists Association 2018;58:450-6. - PubMed
Ralph 2019 {published data only}
    1. Ralph AP, Holt DC, Islam S, Osowicki J, Carroll DE, Tong SYC, et al. Potential for molecular testing for group A Streptococcus to improve diagnosis and management in a high-risk population: a prospective study. Open Forum Infectious Diseases 2019;6:ofz097. - PMC - PubMed
Rao 2019 {published data only}
    1. Rao A, Berg B, Quezada T, Fader R, Walker K, Tang S, et al. Diagnosis and antibiotic treatment of group A streptococcal pharyngitis in children in a primary care setting: impact of point-of-care polymerase chain reaction. BMC Pediatrics 2019;19:24. - PMC - PubMed
Regueras 2012 {published data only}
    1. Regueras De Lorenzo G, Santos Rodríguez PM, Villa Bajo L, Pérez Guirado A, Arbesú Fernández E, Barreiro Hurlé L, et al. Use of the rapid antigen technique in the diagnosis of Streptococcus pyogenes pharyngotonsillitis. Anales de Pediatria 2012;77:193-9. - PubMed
Reichardt 2009 {published data only}
    1. Reichardt B, Pichlhofer O, Zehetmayer S, Maier M. Current diagnosis of acute pharyngitis. Wiener Medizinische Wochenschrift 2009;159:202-6. - PubMed
Tanz 2018 {published data only}
    1. Tanz RR, Zheng XT, Carter DM, Steele MC, Shulman ST. Caution needed: molecular diagnosis of pediatric group A streptococcal pharyngitis. Journal of the Pediatric Infectious Disease Society 2018;7:e145-7. - PubMed
Thornton 2017 {published data only}
    1. Thornton HV, Hay AD, Redmond NM, Turnbull SL, Christensen H, Peters TJ, et al. Throat swabs in children with respiratory tract infection: associations with clinical presentation and potential targets for point-of-care testing. Family Practice 2017;34:407-15. - PMC - PubMed
True 1986 {published data only}
    1. True BL, Carter BL, Driscoll CE, House JD. Effect of a rapid diagnostic method on prescribing patterns and ordering of throat cultures for streptococcal pharyngitis. Journal of Family Practice 1986;23:215-9. - PubMed
Worrall 2007b {published data only}
    1. Worrall G, Hutchinson J, Sherman G, Griffiths J. Diagnosing streptococcal sore throat in adults - randomized controlled trial of in-office aids. Canadian Family Physician 2007;53:667-71. - PMC - PubMed
Worrall 2007c {published data only}
    1. Worrall G, Hutchinson J, Sherman G, Griffiths J. Diagnosing streptococcal sore throat in adults: randomized controlled trial of in-office aids. [Erratum appears in Can Fam Physician. 2007 Jun;53(6):1006]. Canadian Family Physician 2007;53:666-71. - PMC - PubMed

References to studies awaiting assessment

Wächtler 2018 {unpublished data only}
    1. Wächtler H, Kaduszkiewicz H, Hansmann-Wiest J, Hedderich J, Wiese B, Maas S, et al. Antibiotics for sore throat in Germany: influence of a guideline or an additional Strep-test on antibiotic prescriptions. In: General Practice Research on Infections Network. 2018. [TRIAL IDENTIFIER: DRKS00013018]

Additional references

Aabenhus 2014
    1. Aabenhus R, Jensen JU, Jørgensen KJ, Hróbjartsson A, Bjerrum L. Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care. Cochrane Database of Systematic Reviews 2014, Issue 11. [DOI: 10.1002/14651858.CD010130.pub2] - DOI - PubMed
AAP 2015
    1. Kimberlin DW (editor). Red Book: 2015 Report of the Committee on Infectious Diseases. 30th edition. Elk Grove Village, IL: American Academy of Pediatrics, 2015.
Adams 2004
    1. Adams G, Gulliford MC, Ukoumunne OC, Eldridge S, Chinn S, Campbell MJ. Patterns of intra-cluster correlation from primary care research to inform study design and analysis. Journal of Clinical Epidemiology 2004;57(8):785-94. - PubMed
Atkins 2004
    1. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ 2004;328(7454):1490. [PMID: ] - PMC - PubMed
Ayanruoh 2009
    1. Ayanruoh S, Waseem M, Quee F, Humphrey A, Reynolds T. Impact of rapid streptococcal test on antibiotic use in a pediatric emergency department. Pediatric Emergency Care 2009;25(11):748-50. - PubMed
Carlet 2012
    1. Carlet J. World Alliance Against Antibiotic Resistance (WAAR): safeguarding antibiotics. Intensive Care Medicine 2012;38(10):1723-4. [PMID: ] - PubMed
CDC 2012
    1. Centers for Disease Control and Prevention. National Ambulatory Medical Care Survey: 2012 state and national summary tables. www.cdc.gov/nchs/data/ahcd/namcs_summary/2012_namcs_web_tables.pdf.
Chahwakilian 2011
    1. Chahwakilian P, Huttner B, Schlemmer B, Harbarth S. Impact of the French campaign to reduce inappropriate ambulatory antibiotic use on the prescription and consultation rates for respiratory tract infections. Journal of Antimicrobial Chemotherapy 2011;66(12):2872-9. - PubMed
Cohen 2015
    1. Cohen JF, Cohen R, Levy C, Thollot F, Benani M, Bidet P, et al. Selective testing strategies for diagnosing group A streptococcal infection in children with pharyngitis: a systematic review and prospective multicentre external validation study. Canadian Medical Association Journal 2015;187(1):23-32. [PMID: ] - PMC - PubMed
Cohen 2016
    1. Cohen JF, Bertille N, Cohen R, Chalumeau M. Rapid antigen detection test for group A streptococcus in children with pharyngitis. Cochrane Database of Systematic Reviews 2016, Issue 7. [DOI: 10.1002/14651858.CD010502.pub2] - DOI - PMC - PubMed
Ebell 2000
    1. Ebell MH, Smith MA, Barry HC, Ives K, Carey M. The rational clinical examination. Does this patient have strep throat? JAMA 2000;284(22):2912-8. [PMID: ] - PubMed
Fine 2012
    1. Fine AM, Nizet V, Mandl KD. Large-scale validation of the Centor and McIsaac scores to predict group A streptococcal pharyngitis. Archives of Internal Medicine 2012;172(11):847-52. - PMC - PubMed
Fleming‐Dutra 2016
    1. Fleming-Dutra KE, Hersh AL, Shapiro DJ, Bartoces M, Enns EA, File TM Jr, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA 2016;315(17):1864-73. - PubMed
Gerber 2004
    1. Gerber MA, Shulman ST. Rapid diagnosis of pharyngitis caused by group A streptococci. Clinical Microbiology Reviews 2004;17(3):571-80. [PMID: ] - PMC - PubMed
Goossens 2005
    1. Goossens H, Ferech M, Vander Stichele R, Elseviers M. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005;365(9459):579-87. [PMID: ] - PubMed
Higgins 2011
    1. Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Hong 2011
    1. Hong SY, Taur Y, Jordan MR, Wanke C. Antimicrobial prescribing in the USA for adult acute pharyngitis in relation to treatment guidelines. Journal of Evaluation in Clinical Practice 2011;17(6):1176-83. [PMID: ] - PMC - PubMed
Joachim 2010
    1. Joachim L, Campos D Jr, Smeesters PR. Pragmatic scoring system for pharyngitis in low-resource settings. Pediatrics 2010;126(3):e608-14. - PubMed
Laxminarayan 2013
    1. Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al. Antibiotic resistance - the need for global solutions. Lancet Infectious Diseases 2013;13(12):1057-98. [PMID: ] - PubMed
Lean 2014
    1. Lean WL, Arnup S, Danchin M, Steer AC. Rapid diagnostic tests for group A streptococcal pharyngitis: a meta-analysis. Pediatrics 2014;134(4):771-81. [PMID: ] - PubMed
Linder 2005
    1. Linder JA, Bates DW, Lee GM, Finkelstein JA. Antibiotic treatment of children with sore throat. JAMA 2005;294(18):2315-22. [PMID: ] - PubMed
Little 2014
    1. Little P, Hobbs FR, Moore M, Mant D, Williamson I, McNulty C, et al. PrImary care Streptococcal Management (PRISM) study: in vitro study, diagnostic cohorts and a pragmatic adaptive randomised controlled trial with nested qualitative study and cost-effectiveness study. Health Technology Assessment 2014;18(6):vii-xxv. [PMID: ] - PMC - PubMed
Moher 2009
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. BMJ 2009;339:2535. - PMC - PubMed
Pouwels 2018
    1. Pouwels KB, Dolk FCK, Smith DRM, Robotham JV, Smieszek T. Actual versus 'ideal' antibiotic prescribing for common conditions in English primary care. Journal of Antimicrobial Chemotherapy 2018;73(Suppl 2):19-26. - PMC - PubMed
Review Manager 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Shaikh 2010
    1. Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics 2010;126(3):e557-64. [PMID: ] - PubMed
Shaikh 2012
    1. Shaikh N, Swaminathan N, Hooper EG. Accuracy and precision of the signs and symptoms of streptococcal pharyngitis in children: a systematic review. Journal of Pediatrics 2012;160(3):487-93.e3. [PMID: ] - PubMed
Shulman 2012
    1. Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clinical Infectious Diseases 2012;55(10):e86-102. [PMID: ] - PMC - PubMed
Spinks 2013
    1. Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database of Systematic Reviews 2013, Issue 11. [DOI: 10.1002/14651858.CD000023.pub4] - DOI - PMC - PubMed
Tanz 2009
    1. Tanz RR, Gerber MA, Kabat W, Rippe J, Seshadri R, Shulman ST. Performance of a rapid antigen-detection test and throat culture in community pediatric offices: implications for management of pharyngitis. Pediatrics 2009;123(2):437-44. - PubMed
Vandenbroucke 2004
    1. Vandenbroucke JP. Benefits and harms of drug treatments. BMJ 2004;329(7456):2-3. - PMC - PubMed
Wessels 2011
    1. Wessels MR. Clinical practice. Streptococcal pharyngitis. New England Journal of Medicine 2011;364(7):648-55. - PubMed

References to other published versions of this review

Cohen 2016b
    1. Cohen JF, Pauchard JY, Hjelm N, Cohen R, Chalumeau M. Efficacy and safety of rapid tests to guide antibiotic prescriptions for sore throat. Cochrane Database of Systematic Reviews 2016, Issue 11. [DOI: 10.1002/14651858.CD012431] - DOI - PMC - PubMed

Publication types

Substances