Department of Emergency Medicine, Etobicoke Campus of William Osler Health Centre, Toronto, Ontario, Canada.
CJEM. 2002 May;4(3):178-84. doi: 10.1017/s1481803500006357.
Reducing the number of unnecessary antibiotic prescriptions given for common respiratory infections has been recommended as a way to limit bacterial resistance. This study assessed the validity of a clinical sore throat score in 2 community emergency departments (EDs) and its impact on antibiotic prescribing. We also attempted to improve on this approach by using a rapid streptococcal antigen test.
A total of 126 patients with new upper respiratory tract infections accompanied by sore throat were assessed by a physician. Pharyngeal swabs were obtained for a rapid test and throat culture, and information was gathered to determine the sore throat score. The sensitivity and specificity of the score approach were compared with usual physician care based on the rapid test results.
Of the 126 cases of new upper respiratory infections with sore throat, physicians who followed their usual care routine, guided by the rapid test results, prescribed antibiotics for 46 patients. Of the 46 prescriptions, 18 were given to patients with culture-negative results for group A streptococcal (GAS) pharyngitis. Use of the sore throat score would not have reduced the number of prescriptions but would have missed only 1 patient with a positive culture result (p < 0.05). The rapid test was not as sensitive as throat culture.
An explicit clinical score approach to the management of GAS pharyngitis is valid in a community ED setting and could improve the pattern of antibiotic prescribing. While the addition of a rapid streptococcal antigen test significantly decreased the sensitivity of detecting GAS infections, a combined approach consisting of the clinical score and throat culture for patients with negative results on the rapid test would decrease antibiotic prescribing and telephone follow-up without decreasing the sensitivity of detecting GAS infection.
减少因常见呼吸道感染而开具的不必要抗生素处方已被推荐为限制细菌耐药性的一种方法。本研究评估了社区急诊部门（ED）中临床咽痛评分的有效性及其对抗生素处方的影响。我们还尝试通过使用快速链球菌抗原检测来改进这种方法。
共有 126 名新出现的上呼吸道感染伴咽痛的患者接受了医生的评估。采集咽拭子进行快速检测和咽拭子培养，并收集信息以确定咽痛评分。基于快速检测结果，比较了评分方法与常规医生治疗的敏感性和特异性。
在 126 例新出现的上呼吸道感染伴咽痛的病例中，根据快速检测结果指导常规医疗常规的医生为 46 例患者开具了抗生素。在这 46 例处方中，有 18 例是针对 A 组链球菌（GAS）咽炎的培养阴性结果开出的。使用咽痛评分不会减少处方数量，但会错过 1 例培养阳性结果的患者（p<0.05）。快速检测不如咽拭子培养敏感。
在社区 ED 环境中，明确的临床评分方法管理 GAS 咽炎是有效的，并且可以改善抗生素处方模式。虽然快速链球菌抗原检测的添加显著降低了检测 GAS 感染的敏感性，但对于快速检测结果阴性的患者，结合临床评分和咽拭子培养的方法，可以减少抗生素处方和电话随访，而不会降低检测 GAS 感染的敏感性。
