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‘Clinical Score’ for Patients With Sore Throats Cuts Antibiotic Use

Test reduces antibiotic prescriptions by almost 30% (November 8)

A new “clinical score” test for patients with sore throats could reduce the amount of antibiotics prescribed and result in patients feeling better more quickly, a study published in the British Medical Journal suggests.

Researchers at the University of Southampton in the U.K. used the five-item FeverPAIN score to decide whether to prescribe patients with an antibiotic immediately or to give them a delayed prescription and compared it with simply offering a delayed prescription.

The FeverPAIN score includes fever in the past 24 hours, a pus infection, rapid attendance (within 3 days), inflamed tonsils, and no cough or cold symptoms.

Results showed that using the test reduced antibiotic use by almost 30%, and despite using fewer antibiotics, patients in the FeverPAIN score group experienced a greater improvement in symptoms.

In contrast, the use of an in-practice rapid antigen test (a test that detects Lancefield Group A Streptococcus, the most common bacterium to cause sore throats) in conjunction with the FeverPAIN score did not result in further reductions in antibiotic use or improvements in symptoms.

The study recruited 631 patients with an acute sore throat and compared the use of the FeverPAIN clinical score, with or without rapid antigen testing, with a delayed prescription, in which patients were told to pick up a prescription 3 to 5 days later if their symptoms did not settle or got worse.

The clinical score test led to a 29% reduction in antibiotic use compared with the delayed-prescription approach. One in three patients in the FeverPAIN score group said their sore throat had improved rapidly from a moderately bad problem to a slight problem within 2 to 4 days. Moderately bad or worse symptoms also got better faster in the clinical-score group.

Co-author Dr. Michael Moore said: “Clinicians can consider using a clinical score to target antibiotic use for acute sore throat, which is likely to reduce antibiotic use and improve symptom control. There is no clear advantage in the additional use of a rapid antigen test.”

Source: University of Southampton; November 8, 2013.

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