Summary
BACKGROUND: Throat infections with Group A Streptococci have a high incidence and are, therefore, a considerable health problem. It is, therefore, desirable to distinguish this bacterial infections from viral infections of the upper respiratory tract. We report about the application of an immunologic rapid antigen detection test for Group A Streptococci and its medical and economic implications. METHODS: In a cross-sectional cohort study, 30 family physicians documented the application of the test in 519 patients. Follow-up costs were compared with 109 family physicians who did not have access to the test. RESULTS: 40.27% of tests performed were positive for Streptococci. 99% of those patients received antibiotic treatment – predominantly with Penicillin. From those patients who had shown a negative test result, only 18.4% received antibiotic treatment. Both patients and physicians welcomed the availability of the test. We did not find any significant difference regarding the economic effect of the test. CONCLUSIONS: The employment of a rapid antigen detection test for Group A Streptococci in patients with acute pharyngitis increases therapeutic certitude and guideline-conform prescription of antibiotics among family physicians. We, therefore, assume that potential side effects of unnecessary antibiotic treatments could be minimized.
Zusammenfassung
GRUNDLAGEN: Racheninfekte mit Gruppe-A-Streptokokken sind wegen ihrer Häufigkeit ein beträchtliches Gesundheitsproblem. Eine klare Differenzierung zu viralen Infekten ist daher wünschenswert. Wir berichten über den Einsatz eines immunologischen Schnelltests auf Gruppe-A-Streptokokken sowie dessen medizinische und ökonomische Auswirkungen. METHODIK: In einer Querschnittsstudie wandten 30 Burgenländische Ärzte für Allgemeinmedizin den Test an und dokumentierten den Einsatz bei 519 Patienten an Hand eines Dokumentationsbogens. Als Kohortenstudie angelegt, wurden die Folgekosten mit 109 Ärzten für Allgemeinmedizin, denen der Test nicht zur Verfügung stand, verglichen. ERGEBNISSE: 40,27 % der durchgeführten Tests auf Streptokokken waren positiv. Von diesen Patienten erhielten 99 % ein Antibiotikum – überwiegend Penicillin. Bei einem negativen Testergebnis erhielten nur 18,4 % der Patienten ein Antibiotikum. Sowohl Ärzte als auch Patienten zeigten eine positive Einstellung gegenüber der Durchführung des Tests. Bezüglich der ökonomischen Konsequenzen ergab sich kein signifikantes Resultat. SCHLUSSFOLGERUNGEN: Die Durchführung eines immunologischen Schnelltests auf Gruppe-A-Streptokokken bei der akuten Pharyngitis verbessert die therapeutische Sicherheit und das leitlinienkonforme Vorgehen bei der Verschreibung von Antibiotika. Potentielle Nebenwirkungen durch unnötigen Antibiotikagebrauch sollten dadurch reduziert werden.
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Reichardt, B., Pichlhöfer, O., Zehetmayer, S. et al. Die zeitgemäße Diagnostik der akuten Pharyngitis. Wien Med Wochenschr 159, 202–206 (2009). https://doi.org/10.1007/s10354-009-0672-x
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DOI: https://doi.org/10.1007/s10354-009-0672-x