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Impact of Rapid Streptococcal Test on Antibiotic Use in a Pediatric Emergency Department

Ayanruoh, Steve MD; Waseem, Muhammad MD; Quee, Frances MD; Humphrey, Alyssa MD; Reynolds, Toussaint MD

doi: 10.1097/PEC.0b013e3181bec88c
Original Articles

Acute pharyngitis is commonly seen in children. Group A β-hemolytic Streptococcus is the most common bacterial cause of acute pharyngitis and accounts for approximately 15% to 30% of cases in children, but this condition is generally overdiagnosed and overtreated. The availability of rapid streptococcal tests (RSTs) have made this diagnosis simpler and reduced the use of antibiotics. Overuse of antibiotics leads to drug-resistant bacterial strains. Reducing the number of antibiotic prescriptions provided for upper respiratory tract infections has been strongly recommended to limit bacterial resistance.

Objective: To assess the impact of RSTs on antibiotic prescriptions in children with pharyngitis in the emergency department.

Methods: A retrospective study from September 2005 to September 2007 of all patients (3-18 years old) presenting to the pediatric emergency department with sore throat as the chief complaint or suspected clinically to have acute pharyngitis and who had an RST performed. Patients with a negative RST result had a culture performed. The information of the patients with the diagnosis of pharyngitis was also collected in a 2-year control period before the availability of the test. Patients with a negative RST result had a culture performed. In addition, the antibiotic prescriptions for these patients were also recorded.

Results: A total of 8280 patients were included in the study. Throat culture results of 1723 patients were reviewed in the pre-RST phase. During the post-RST phase, 6557 children underwent RST. The RST results were positive in 1474 children (22.5%) and negative in 5083 patients (77.5%). Rapid strep testing was associated with a lower antibiotic prescription rate for children with pharyngitis (41.38% for those treated in the pre-RST phase versus 22.45% for those treated in the post-RST phase; P < 0.001).

Conclusions: The availability of a RST could substantially reduce the unnecessary prescription of antibiotics. This study supports the screening of all children with pharyngitis by performing an RST to guide decision making for antibiotic administration. This strategy has a significant impact on reducing the antibiotic prescription rate to almost 50%. In addition, only 2 children (0.04%) had negative rapid antigen test results with cultures positive for Streptococcus.

From the Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, NY.

Reprints: Steve Ayanruoh, MD, Department of Emergency Medicine, Lincoln Medical and Mental Health Center, 234 E 149th St, Bronx, NY 10451 (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.