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Can Fam Physician
Vol. 53, No. 4, April 2007, pp.666 - 671
Copyright © 2007 by The College of Family Physicians of Canada
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Research

Diagnosing streptococcal sore throat in adults

Randomized controlled trial of in-office aids

Graham Worrall, MBBS MSc MRCGP FCFP
Professor of Family Medicine at Memorial University of Newfoundland in St John’s

James Hutchinson, MD FRCPC
Associate Professor of Medicine at Memorial University of Newfoundland

Gregory Sherman, MD CCFP
Assistant Professor of Family Medicine at Memorial University of Newfoundland

Joseph Griffiths, MSc
PhD candidate at the University of Waterloo in Ontario

Correspondence to: Dr Graham Worrall, Centre for Rural Health Studies, Whitbourne, NL A0B 3K0; telephone 709 759-2300; fax 709 759-2387; e-mail gworrall{at}mun.ca

OBJECTIVE To determine whether use of clinical decision rules or rapid streptococcal antigen detection tests (alone or in combination) can lower the number of unnecessary prescriptions for antibiotics for adults with acute sore throats.

DESIGN Four-arm randomized controlled trial.

SETTING Family practice offices in eastern Newfoundland.

PARTICIPANTS Forty urban and suburban family practitioners.

INTERVENTIONS Participants were randomly assigned to one of 4 arms (usual practice, decision rules only, rapid antigen test only, decision rules and antigen test combined), and each recruited successive adult patients presenting with acute sore throat as their main symptom. Following usual care or use of decision rules or rapid antigen tests or both (where applicable), physicians were to record what they prescribed for each patient.

MAIN OUTCOME MEASURES Prescribing rates and types of antibiotics prescribed.

RESULTS The prescribing rate using decision rules (55%) did not differ significantly from the rate using usual clinical practice (58%). Physicians using rapid antigentests, both alone and with decision rules, had significantly lower prescribing rates (27% and 38%, respectively, both P < .001).

CONCLUSION Evidence-based clinical decision rules alone do not change family doctors’ prescribing behaviour. Use of rapid antigen tests might allow physicians to persuade patients that negative results (and hence, viral infection) mean antibiotic therapy is not required.


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P. Morton
Should we treat strep throat with antibiotics?
Can Fam Physician, August 1, 2007; 53(8): 1299 - 1299.
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