Rapid antigen test to detect strep A infection in patients with sore throat: evidence from a pathfinder NHS Sore Throat Test & Treat service in community pharmacies in Wales
Background: A pathfinder Sore Throat Test and Treat service (STTT) was rolled out in 56 community pharmacies in Wales in November 2018, as part of a wider approach to safely rebalance management of uncomplicated conditions from GPs to community pharmacists. STTT included clinical assessment of patients 6 years and over, using clinical scoring criteria (Centor and/or FeverPAIN), a rapid antigen detection test (RADT) to detect strep A infection when threshold scores are met, and allowance for antibiotic supply in the pharmacy, in line with NICE guidance1, if the test is positive.Aim: To explore the added value of RADT for group A streptococcal infections in people with a sore throat, as part of the STTT service in community pharmacies
Methodology: Secondary data analysis of STTT consultation data between November 2018 (date the service went live) and March 2019, obtained from Choose Pharmacy, the national IT platform used in 98% community pharmacies in Wales to record services. Data were analysed using Microsoft Excel®. No ethical approval was required for the study.
Results: A total of 1,235 patients met the clinical scoring criteria to be offered RADT within the study period. A total of 901/1235 patients (73%) did not receive an antibiotic supply as they had a negative result from their RADT. Of the 334 (27%) that did receive an antibiotic this rate varied by their clinical score from 12% (58/481) in those with FeverPAIN score of 2 to 71% (60/84) in those with a FeverPAIN score of 5. When we only consider Centor score 3 or 4 and FeverPAIN score 4 or 5, the corresponding number is 181/368 patients (49.2%).
Conclusion: Data from the first five months of the pathfinder service suggests that almost half of the patients who would have been offered an immediate antibiotic or back-up antibiotic prescription according to NICE guidance, were not offered antibiotics as the RADT results were negative. This preliminary data suggests that RADT may play a role in antimicrobial stewardship, by reducing the number of antibiotics prescribed for sore throat symptoms.1. NICE guideline [NG84]. Sore throat (acute): antimicrobial prescribing. January 2018. Available at: https://www.nice.org.uk/guidance/ng84