The High Necessity of Rapid Antigen Detection Test (RADT) use to Guide Antibiotic Prescribing Pattern for Acute Pharyngotonsillitis in Syria

Abstract

The objectives of this study were to assess the percentage of the inappropriate antibiotics prescribing for clinically diagnosed Group A β-hemolytic streptococcus (GABHS) caused acute pharyngotonsillitis (APT), and to investigate factors influencing this prescribing and the possibility and necessity of routine usage of RADT for rational treatment of APT in different primary care facilities in Latakia, Syria. Throat swabs were collected from 80 patients, ≥ 5 years old, seen in urban or rural pharmacies, otolaryngology clinic or emergency unit of University Tishreen hospital over a period of 6 months, who were diagnosed and treated for APT depending on clinical findings. RADT was applied and McIsaac score (MIS) was recorded for all patients. Throat cultures were done only for negative RADT cases seen in the hospital. The chi square (χ2) statistical test was used for comparing categorical variables. A P value of <0.05 was considered significant. Antibiotics were prescribed for 59 patients (74%) among them RADT results were positive for only 9 patients (15.25%) with a percentage of inappropriate antibiotic prescribing of (84.75%). Cultures were GABHS negative for all negative RADT cases. The most frequently prescribed antibiotic was azithromycin (50.8%). Antibiotics prescribing was significantly influenced by the presence of fever (P=0.041), anterior cervical adenitis (P=0.0003), and MIS≤0 (P=0.0001). We found a significance association of the presence of tonsillar exudate (P=0.013) and MIS≥4 (P=0.002) with positive RADT results. There was no significant difference in antibiotic prescribing according to age, sex or place of consultation. Our findings highlight the great need to use RADT in clinical practice as important adjuvant tool in APT diagnosis to reduce the percentage of antibiotic prescribing and so limiting of bacterial resistance.