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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%.