Antibiotics Are Often Prescribed for Sore Throats Without a Diagnostic Test

Despite best practice recommendations, antibiotics continue to often be prescribed without a streptococcal antigen test or culture, results from a study by Epic Research show.¹

This trend has been going on since before the start of the COVID-19 pandemic and is the cause of both in-person and telehealth visits, Epic Research said in a statement.¹

The instances in which antibiotics were prescribed without testing increased from 50.7% to 53.0% (for office visits), 72.6% to 85.5% (telephone visits), and 77.9% to 86.8% (urgent-care visits). The percentage of telehealth encounters during which antibiotics were prescribed without testing increased from 90.6% to 98.3%.

The surge in telehealth use during the pandemic might have contributed to this increase because telehealth was often used interchangeably with telephone and urgent-care visits, according to Epic Research.¹

The data could also be influenced by changes related to the overall decrease in communicable infections while people were sheltering in place, distancing socially, and wearing masks, according to Epic Research.¹ Overall, both before and during the pandemic, the rate of antibiotic prescriptions given for sore throats without an accompanying strep test was alarmingly high, which raises concerns about future antimicrobial resistance, according to Epic Research.¹ Sore throats can be caused by bacteria or viruses, and about 50% to 70% of those cases are treated with antibiotics.²

However, antibiotics do not help when a sore throat has viral origins, so rapid antigen tests to determine cause would be extremely useful. Administering the antigen tests would also help physicians properly diagnose sore throats and prescribe medication. Based on data from multiple trials, there was a significant reduction in prescribed antibiotics when a rapid test was used.²

A rapid antigen test should be ordered for individuals who have a modified Centor or FeverPAIN score of 2 or 3 to help diagnose group A beta-hemolytic streptococcal (GABHS) infection, according to results published in American Family Physician.³ GABHS infections cause about 5% to 15% of sore throats in adults and 15% to 30% in children.³

It is recommended that physicians diagnose infection by combining the modified Centor or FeverPAIN test with the rapid antigen detection test before prescribing an antibiotic.

References

1. Butler S, Rubin-Miller L, Bowlin G, et al. Pandemic or not: strep-testing guidance overlooked for the majority of prescriptions. Epic Research. No- vember 30, 2021. Accessed January 7, 2022. https://epicresearch.org/articles/ pandemic-or-not-strep-testing-guidance-overlooked-for-the-majority-of- prescriptions

2. Cohen JF, Pauchard JY, Hjelm N, et al. Efficacy and safety of rapid tests to guide antibiotic prescriptions for sore throat. Cochrane Database Syst Rev. 2020;6:CD012431. doi:10.1002/14651858.CD012431.pub

3. Kalra MG, Higgins KE, Perez ED. Common questions about streptococcal pharyngitis. Am Fam Physician. 2016:94(1):24-31.