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NICE review finds new strep A test could help GPs reduce antibiotics for sore throat

New tests for diagnosing strep A throat infections could provide GPs with instant results and potentially reduce antibiotic prescribing, NICE has suggested.

Eleven point-of-care tests were looked at in the technology briefing which said that they could support GPs when deciding whether antibiotics are required, and could cut GP visits if implemented in community pharmacy settings alongside practices.

However GP experts have said that while it might cut out unnecessary prescribing, it may miss some cases.

This comes after the Department of Health and Social Care’s chief medical officer sent over 8,000 GPs personalised letters last month telling them that they are overprescribing antibiotics.

The NICE medical technology innovation briefing looked at four prospective studies, one pilot study and one systematic review, which included over 100,000 patients, of whom 3,552 were tested with the technologies.

This evidence was considered alongside five expert opinions.

The technology included nine rapid antigen detection tests. These involve taking a throat swab from the patient, which is then applied to an adsorbent pad on the end of the test strip. A test line will appear if strep A is present.

The other two tests used nucleic acid amplification techniques.

The briefing, which is intended for clinicians and commissioners, said that these tests are designed to give a ‘more accurate confirmation’ of the presence of bacterial infection than clinical evaluation, including clinical scoring systems.

It continued: ‘This is aimed at improving antibiotic prescribing in line with local guidelines, which may help to reduce antimicrobial resistance.

‘The quick “time to result” of the tests compared with laboratory testing aims to help treatment decisions to be made during a single GP or community pharmacy visit, without the need to wait for laboratory tests results.’

The guidance also said that while the tests would incur an additional cost to standard care, they could save money by cutting GP appointments and antibiotic prescriptions.

Participating expert Professor Jonathan Cooke, who works at both the University of Manchester and Imperial College London, said: ‘The strep A point-of-care tests would be used in GP practices and community pharmacies for people with acute sore throat and when a FeverPAIN score of 4 or 5 or a Censor score of 3 or 4 has shown that a strep A infection is likely and the health professional is considering prescribing antibiotics.

‘They may also be used in primary care to help to support the decision not to prescribe antibiotics for people with a FeverPAIN score of 0 or 1 or a Centor score of 0, 1 or 2.’

He added: ‘There is good evidence that the use of the tests reduces the index prescribing of antibiotics and hence contributes to the UK Antimicrobial Resistance Strategy.’

However fellow expert panel member Professor Michael Moore, head of primary care and population sciences at Southampton University and a GP in Salisbury, said: ‘The current strep tests available are sensitive and specific for only one of the important sore throat bugs, strep A. Other bugs, strep C and G, are relevant pathogens in UK primary care.

‘So although use of the strep test might cut out unnecessary prescribing it may well miss some cases.’

Earlier this year Public Health England claimed that one in five GP antibiotic prescriptions is inappropriate.

The PHE-commissioned research compared actual and ideal prescribing, and found that for sore throat consultations the ideal was 13% while the actual was 59%.

Readers' comments (8)

  • Took Early Retirement

    What about other bacteria that may be causing an infection WITHIN the tonsil? Tonsillectomy specimens grow an awful lot of "other" bacteria that may or may not be relevant.

    Also, pus dripping down from infected sinuses is a potent cause of a painful throat, as I know from personal experience.

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  • Does the 'Department of Health and Social Care’s chief medical officer' have to deal with personal complaints about him?
    Tonsils are covered in bacteria. That's what they are there for (protecting the most vulnerable entry to your body or somewhat).
    Finding 'bugs on your tonsils' means nothing!
    PS 'Family Doctors' in USA do these tests routinely and give abx and charge like a 'Wounded Rhino' and call it 'Best Practice'.

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  • Cobblers

    NICE says "The resource impact would initially be greater than standard care because of the additional test costs.

    OK NHSE & PHE let's see the colour of your money. No way should you expect GPs to fund this lot through their own pockets.

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  • No need to develop clinical skills folk! Why believe your doctor when a test , that you can buy, will surely be more reliable?

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  • How will Babylon do this?

    Oh....they won’t.

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  • great if you only do the test when you see someone you want to give antibiotics to with purulent tonsils fever for a week looking a bit rubbish then a negative strep test means one less antibiotic prescription. when i worked in canada many doctors did it as a screning test for everyone wone with urti even those with no sore throat, hence over diagnosis and over treatment in those just colonised with strep which is 20% in kids. if pharmacies will be doing these to all sore throat and as above they mention doing it on those with 0 or 1 centor score to reassure them abx not needed. guess what? that will mean giving abx to 20% of viral infections because thats how many are just colonised. the test does not mean strep is causing infection just that its present so it has to look like a strep infection to mean anything.

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  • David Banner

    - The test clearly isn’t specific/sensitive enough.
    - Colonising strep will result in inappropriate penicillin
    - Negative result may miss a life threatening sepsis
    - Missing sepsis can land you in court (“So doctor, you relied on a discredited throat swab rather than your clinical acumen”.
    - Performing throat swabs on gagging reluctant patients and children is like Russian roulette. Be honest, do you ALWAYS hit the target?
    - No GP in their right mind will self fund these tests

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  • Where is the funding for this? Ah, I get it. The old trick of removing some payments from GPs and asking GPs to fund it as it is a new not so NICE guidance.

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