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Antimicrobial stewardship

Rapid tests for strep A not recommended for sore throat by NICE

Rapid tests for group A streptococcal (strep A) infections have not been recommended for routine adoption for people with a sore throat.

In diagnostics guidance, published on 13 November 2019, the National Institute of Health and Care Excellence (NICE) said the effect of rapid tests for strep A on improving antimicrobial prescribing and stewardship, and patient outcomes, was likely to be limited compared to clinical scoring tools alone.

As a result, NICE said that they were “unlikely” to be a cost-effective use of NHS resources.

“The predicted reduction in antibiotic use is included in the cost-effectiveness analyses for using rapid tests in people with a sore throat, but the resulting incremental cost-effectiveness ratios are much higher than what NICE usually considers acceptable,” the guidance said.

It added that the diagnostic accuracy of these rapid tests in routine clinical practice was “uncertain” and likely to be “highly variable”.

Although the NICE committee was aware that these rapid tests may be available in some community pharmacies, no evidence was found on the diagnostics or clinical utility of rapid test accuracy when used in pharmacies and, therefore, the committee concluded that it was not possible to assess the cost effectiveness of rapid tests for use in this setting.

In NICE’s guidance on antimicrobial prescribing for acute sore throat, it advises that a sore throat is self-limiting and so, antibiotics are usually not needed in people who are otherwise healthy, regardless of the cause.

  • This article was amended on 18 November 2019 to remove the reference to the ‘test and treat’ scheme in Welsh community pharmacies and to clarify that the cost effectiveness of these rapid tests for use in community pharmacies was not assessed by the NICE committee.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20207331

Readers' comments (1)

  • Yes, v often an expertise clinical exam is more revealing than a rapid strep test, especially when a throat swab is inadequately performed. Uvular involvement-with redness and some swelling, and hemorrhagic lesions on the palate point to Beta hemolytic strep, irrespective of presence or absence of pus. Additional clinical findings could be meningismus, especially in severe cases.

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