Reducing Antibiotic Misuse Through the Use of Point-of-Care Tests in Germany – A Multicenter Study

OBJECTIVES:

Acute pharyngitis is in more than 80% of viral etiology, though it remains one of the most common causes for unnecessary prescription of antibiotics. Half of patients receive antibiotics in general practice. Throat swab testing (TST) distinguishes between bacterial and viral pharyngitis. The objective of this study was to evaluate the administration of TST to detect Group A streptococci infection in primary care.

METHODS:

A multicenter study was conducted in 1,257 primary care practices. Two questionnaires were administered concerning frequency, results of TST and whether antibiotics were prescribed.

RESULTS:

Of the 1,257 physicians, 60% used TST. Of these, 25% used TST before prescribing an antibiotic, 39% used in severe sore throat, 40% used in long-lasting pharyngitis, and 25% used in other cases. In total, 83% considered the adoption of TST into everyday practice as important for diagnosis of Streptococci Group A, 90% as important or very important for a more sensible use of antibiotics and the prevention of bacterial resistance, and 80% considered it important to justify to patients whether or not an antibiotic is needed. TST results were available for 619 patients. Of these, 22.5% tested positive for strep throat, and 26% were prescribed antibiotics.

CONCLUSIONS:

The use of a swab test in sore throat is an easy technique that can strongly reduce the misuse of antibiotics in clinical practice. In our study we were able to show that the prescription of antibiotics for ST was reduced by 50% after testing. Similar results were shown in studies performed in Portugal and New Zealand on TST in primary care.