Study: Antibiotics Are Often Prescribed for Sore Throats Without a Diagnostic Test

Despite best practice recommendations, prescriptions for acute pharyngitis are frequently not accompanied by testing, Epic Research data show.

Despite best practice recommendations, antibiotics continue to often be prescribed without a streptococcal antigen test or culture, results from a study by Epic Research show.1

This trend is not new and has been present since before the start of the COVID-19 pandemic and is the case for both in-person and telehealth visits, Epic Research said in a statement.1

For office visit, telephone, and urgent-care encounters, the percentage of the times in which antibiotics were prescribed without testing increased to 53.0% from 50.7%, to 85.5% from 72.6%, and to 86.8% from 77.9%, respectively. However, the percentage of telehealth encounters in which antibiotics were prescribed without testing increased to 98.3% from 90.6%.

The large increase in telehealth use during the pandemic might have contributed to this decrease, because telehealth was often used interchangeably with telephone or urgent-care visits, bringing the percentage of antibiotics prescribed closer to those levels, according to Epic Research.1

The data could also be influenced by changes related to the overall decrease in communicable infections while patients were sheltering in place, socially distancing, and wearing masks, according to Epic Research.1 Overall, both before and during the pandemic, the rate of sore throat encounters with antibiotic prescriptions but without an accompanying strep test is alarmingly high, which raises concerns about future antimicrobial resistance, according to Epic Research.1 Sore throats can be caused by either bacteria or viruses, and about 50% to 70% of those cases are treated by antibiotics.2

However, antibiotics do not help when a sore throat has viral origins, so rapid antigen tests would be extremely useful to determine the cause of acute pharyngitis. Administering the antigen tests would also help physicians properly diagnose and prescribe medication for patients with sore throats. Based on data from multiple trials, there was a large reduction in prescribed antibiotics when a rapid test was used.2

A rapid antigen test should be ordered for individuals who have a modified Centor or FeverPAIN score of 2 or 3 to help diagnose a group A beta-hemolytic streptococcal (GABHS) infection, according to study results published in American Family Physician.3 So, it is recommended that physicians should diagnose the infection by combining the modified Centor or FeverPAIN test with the use of a rapid antigen detection testing before prescribing an antibiotic.

GABHS infections cause about 5% to 15% of sore throats in adults and 15% to 30% of those in children.3

References

1. Butler, S, Rubin-Miller, L, Bowlin, G, Russell, J, Lo, J, Marchena, D. Pandemic or not: strep-testing guidance overlooked for the majority of prescriptions. Epic Research. November 30, 2021. Accessed January 7, 2022. https://epicresearch.org/articles/pandemic-or-not-strep-testing-guidance-overlooked-for-the-majority-of-prescriptions

2. Cohen JD, Pauchardm J, Hjelm N, Cohen R, Chalumeau M. Efficacy and safety of rapid tests to guid antibiotic prescriptions for sore throat. Cochrane Database Syst Rev.2020;6(6):CD012431.doi:10.1002/14651858.CD012431.pub

3. Kalra MG, Higgins KE, Perez ED. Common questions about streptococcal pharyngitis. AmFam Physician. 2016:94(1):24-31.