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Simple Test Cuts Antibiotic Use Among Sore Throat Patients

White pills in a prescription bottle (


Researchers at University of Southampton and other institutions in the U.K. and Australia found a simple nine-item test can help clinicians better determine if patients complaining of a sore throat need antibiotics. The team led by Southampton’s Paul Little, professor of primary care research, published its findings in a recent issue of the British Medical Journal.

Little — with colleagues from Southampton, University of Oxford, University of Birmingham, Gloucestershire Royal Hospital, and Bond University in Australia — tested a brief online index to help clinicians determine if a patient complaining of a sore throat needed antibiotics immediately, or if the prescription could be delayed to see if the patient’s condition improved. The study was part of a larger clinical trial, PRImary care Streptococcal Management (PRISM) study of rapid tests for streptococcal sore throat.

The FeverPAIN test is an online questionnaire with five items capturing data on the patient’s recent history with his or her condition …

– Sore throat

– Cough or cold symptoms

– Muscle aches

– Fever in the past 24 hours

– Number of days from the onset of illness

The online form also has four items recording results from the patient’s examination: size of cervical (lymph node) glands, inflammation of tonsils, presence of pus on tonsils, and current evidence of fever. The test yields a composite score indicating the likelihood of an infection requiring antibiotics. Patients with higher scores are prescribed antibiotics immediately, those with low scores receive no prescription, and those with moderate scores are given delayed prescriptions — with instructions to fill after three to five days if symptoms persist or get worse.

The trial recruited 631 patients from medical practices in the U.K. complaining of severe sore throat. The study measured the severity and duration of sore throat symptoms reported by patients and their use of antibiotics. The sample was divided among patients (1) evaluated with the FeverPAIN test alone, (2) evaluated with both the FeverPAIN test and a rapid antigen test for Lancefield Group A Streptococcus bacteria, and (3) given instructions to take a prescribed antibiotic if their symptoms persist or get worse after three days.

The results show one in three patients evaluated with only the FeverPAIN test reported rapid improvement in symptoms from moderate to mild within two to four days. Likewise, those with moderate or worse symptoms also said their symptoms improved.

However, those patients evaluated with only the FeverPAIN test used 29 percent fewer antibiotics than patients in the delayed-prescription group. Patients who had both the rapid-antigen and FeverPAIN tests showed similar reports in symptom improvements and reduced use of antibiotics — a 27 percent reduction — compared to the delayed prescription group.

“Our findings show,” says Little in a university statement,  “that using this clinical score test can target antibiotics more effectively and help persuade patients antibiotics are not needed.”

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