Decision analysis and opinion survey suggest that introduction of rapid antigen detection tests should decrease the number
of patients with negative test results for group A streptococcal
pharyngitis treated by antibiotics. We reviewed all cases in which
a test for group A streptococcal pharyngitis was performed during the last 7 months of culture diagnosis and the first 7 months
of antigen test diagnosis at an inner city community health center, recording culture or antigen test results, whether antibiotics
were prescribed, and patient status (as regular health center
patients or patients referred to the center). Positive rates for
culture and antigen-test periods were similar (10% and 12%), but
53% of patients with negative culture were treated, where only
32% of patients with negative antigen-test results received prescriptions. Significant reductions in the treatment of patients
with negative test results were found in both patient-status subpopulations: health center patients, 43% to 29%; referred patients, 91% to 52%. Among health center patients reductions
were consistent for both adult (30% to 21%)) and child and adolescent (55% to 45%) age groups. For all patients with negative test
results, direct costs of diagnostic reagents and antibiotic prescriptions fell from $3.58 per patient with culture to $3.45 with
antigen testing; the $0.13 savings per patient was due to less
treatment of referred patients. Thus, rapid antigen testing led to
(1) significantly fewer patients with negative test results receiving antibiotic prescriptions; and, (2) savings in antibiotic costs
offsetting reagent cost of antigen detection diagnosis.
(Arch Intern Med. 1990;150:1696-1700)
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