Diagnosis and treatment of acute pharyngitis/tonsillitis: a preliminary observational study in General Medicine.

OBJECTIVE: According to recent observations, the insufficiently targeted use of antibiotics is creating increasingly resistant bacterial strains. In this context, it seems increasingly clear the need to resort to extreme and prudent rationalization of antibiotic therapy, especially by the physicians working in primary care units. In clinical practice, actually the general practitioner often treats multiple diseases without having the proper equipment. In particular, the use of a dedicated, easy to use diagnostic test would be one more weapon for the correct diagnosis and treatment of acute pharyngo-tonsillitis. The disease is a condition frequently encountered in clinical practice but its optimal management remains a controversial topic. In this context, the observational study is intended to demonstrate the usefulness of the rapid test (RAD: Rapid antigen detection) against group A beta-hemolytic streptococcus (GABHS) in everyday clinical practice to identify individuals with acute streptococcal pharyngo-tonsillitis needing antibiotic therapy and to pursue the following objectives: (1) Getting the answer to an unmet medical need; (2) Promoting the appropriateness of the use of antibiotics; (3) Provide a means of containment in pharmaceutical spending.

PATIENTS AND METHODS: 50 patients presenting sore throat associated with erythema and/or pharyngeal tonsillar exudate with or without scarlatiniform rash, fever and malaise had been subjected to perform a rapid test (RAD: Rapid antigen detection) for the search of the beta-hemolytic Streptococcus Group A (GABHS). Pharyngeal-tonsillar swabs were tested using Immunospark (relative sensitivity 97.6%, relative specificity 97.5%) according to manufacturer's instructions (runtime/reading response < 10 min).

RESULTS: Of the 50 tests, 45 provided a negative response while 5 were positive for the search of the beta-hemolytic Streptococcus group A. No test result has been invalid.

CONCLUSIONS: Based on the results obtained, only patients with a positive rapid test were subjected to targeted antibiotic therapy. This has resulted in a significant cost savings in pharmaceutical expenditure, without neglecting the more important and correct application of the Guidelines with performing of a clinically validated test that carries advantages for reducing the use of unnecessary and potentially harmful antibiotics and the consequent lower prevalence and incidence of antibiotic-resistant bacterial strains.