Title: Diagnostic testing in primary care from strep A infection in sore throat.
Funder: Department of Health and Social Care

Abstract: Sore throat is a very common condition[2] and the most common symptoms of a sore throat include pain in the throat, fever or a headache. Sore throat is defined as an infection in the upper respiratory airway affecting the mucosa.[3] Sore throats can be described as acute pharyngitis, inflammation of the pharynx; or as acute tonsillitis, inflammation of the tonsils. The highest incidence is in children and young adults, with 50% of cases occurring in people aged 5–24 years.[4] Although most cases of sore throat are viral, around 5%-17% are bacterial, typically Group A beta-haemolytic streptococcus (GABHS), also known as Streptococcus pyogenes or Strep A.[4, 5] Most cases of Strep A infection resolve without complications. Potential complications caused by Strep A include infections such as tonsillitis, pharyngitis, scarlet fever, impetigo, erysipelas (an infection in the upper layer of the skin), cellulitis and pneumonia. According to UK guidelines, antibiotics are only recommended in patients with Strep A sore throat.[6] In order to appropriately identify patients who will likely benefit from antibiotic therapy, NICE recommends the use of the FeverPain or Centor criteria in combination with clinical assessment.[6] Despite this, most patients presenting with sore throat in the UK will be given antibiotics in primary care.[7, 8] Considering the emergence of multi-resistant pathogens, ‘antimicrobial stewardship’ has been a central strategy adopted by the Chief Medical Officer and NICE.[9, 10] Point-of-care diagnostic testing in primary care has been recognised as an emerging technology for aiding targeted antibiotic prescribing in cases of sore throat.[11] Several technologies have been developed for point-of-care diagnostic testing in primary care for appropriate administration of antibiotics to those that would benefit and to prevent delay and associated complications. The External Assessment Group (EAG) aims to assess the diagnostic accuracy and cost-effectiveness of point-of-care diagnostic tests for the detection of Strep A. This diagnostics assessment will inform the NICE Diagnostic Advisory Committee (DAC) guidance on the use of rapid GABHS tests for informing antimicrobial prescribing decisions within the NHS.

Lay abstract: Sore throat is a common condition caused by an infection of the airway. Most cases are of a viral nature, however, a substantial number of these infections may be caused by the Group A Streptococcus (Strep A) bacteria. Most sore throats, including viral and bacterial sore throat infections, resolve spontaneously within a few weeks. To identify patients for whom antibiotic treatment is appropriate, National Institute for Health and Care Excellence (NICE) recommends the use of clinical scoring tools. In spite of this recommendation, there is a huge variation in antibiotic prescription for sore throat in practice; while some general practitioners (GPs) have a very low threshold for prescribing antibiotics for sore throat, others believe that prescribing antibiotics over-medicalises a condition that can largely be managed by self-care.[1] Ideally, a throat swab culture should be undertaken to identify the organism causing the infection in cases where diagnosis is uncertain. However, this takes time, causing potential delays in administering the correct treatment. For these reasons, the external assessment group (EAG) will determine the diagnostic accuracy and cost-effectiveness of 21 point-of-care tests for detecting Strep A bacteria. This assessment will inform the use of these tests within the NHS.

Research activity codes: 4.2 EVALUATION OF MARKERS AND TECHNOLOGIES
Health categories: INFECTION