May 20, 2022

Antibiotics are often prescribed for sore throats without a diagnostic test

Despite best practice recommendations, prescriptions for acute pharyngitis are often not accompanied by testing, according to data from Epic Research.

Despite best practice recommendations, antibiotics often continue to be prescribed without a strep antigen test or culture, according to the results of a study by Epic Research.1

This trend is not new and has been present since before the start of the COVID-19 pandemic and is the case for both in-person and telehealth visits, Epic Research said in a statement.1

For office visits, phone appointments and emergency visits, the percentage of times antibiotics were prescribed without testing increased to 53.0% from 50.7%, to 85.5% from 72 , 6% and 86.8% from 77.9%, respectively. However, the percentage of telehealth encounters in which antibiotics were prescribed without testing increased from 90.6% to 98.3%.

The sharp increase in telehealth use during the pandemic may have contributed to this decrease, as telehealth was often used interchangeably with telephone visits or emergency care, bringing the percentage of antibiotics prescribed closer to those. levels, according to Epic Research.1

The data could also be influenced by changes related to the overall decrease in transmissible infections as patients shelter in place, socially distance themselves and wear masks, according to Epic Research.1 Overall, both before and during the pandemic, the rate of sore throats with prescriptions for antibiotics but no associated strep test is alarming, raising concerns about future antimicrobial resistance, according to Epic Research.1 Sore throats can be caused by bacteria or viruses, and about 50-70% of these cases are treated with antibiotics.2

However, antibiotics do not help when a sore throat has viral origins, so rapid antigenic tests would be extremely helpful in determining the cause of acute pharyngitis. Administering antigen tests would also help doctors correctly diagnose and prescribe medication for patients with sore throats. Based on data from multiple trials, there was a significant reduction in antibiotics prescribed when a rapid test was used.2

A rapid antigen test should be ordered for people who have a modified Centor or FeverPAIN score of 2 or 3 to help diagnose group A beta-hemolytic streptococcal infection (GABHS), according to the results of a study published in American family physician.3 Thus, it is recommended that physicians diagnose the infection by combining the Centor or Modified FeverPAIN test with the use of a rapid antigen test before prescribing an antibiotic.

GABHS infections cause about 5 to 15% of sore throats in adults and 15 to 30% of those in children.3

The references

1. Butler, S, Rubin-Miller, L, Bowlin, G, Russell, J, Lo, J, Marchena, D. Pandemic or not: Strep testing advice is overlooked for the majority of prescriptions. Epic search. November 30, 2021. Accessed January 7, 2022. https://epicresearch.org/articles/pandemic-or-not-strep-testing-guidance-overlooked-for-the-majority-of-prescriptions

2. Cohen JD, Pauchardm J, Hjelm N, Cohen R, Chalumeau M. Efficacy and safety of rapid tests to guide antibiotic prescriptions for sore throat. Cochrane Database System Rev.2020; 6 (6): CD012431.doi: 10.1002 / 14651858.CD012431.pub

3. Kalra MG, Higgins KE, Perez ED. Common questions about strep throat. AmFam Doctor. 2016: 94 (1): 24-31.