New research commissioned by the NIHR Health Technology Assessment (HTA) programme will assess a new test for diagnosis of strep throat, one of the commonest reasons for visits to GPs, costing the NHS up to £60million per annum. Only those sore throats where the cause is bacterial (strep throat) may patients benefit from antibiotics, and bacterial infection accounts for only around one fifth of sore throats. There is currently no clear evidence about tests for the bacteria, but if the new test proves to be effective it could provide significant support to GPs in achieving quick and accurate diagnosis.
The research, led by Professor Paul Little of the University of Southampton, will assess the effectiveness of Rapid Streptococcal Antigen Detection tests (RADTs). These are simple near patient tests, that can be carried out in a GP surgery and provide an immediate diagnosis rather than the current practice of sending swabs away to a lab for analysis. The study will be conducted at three centres, Southampton, Birmingham, and Oxford over a four year period involving up to 1000 adults and children. Phase one will assess which RADT is the most effective for detecting whether the sore throat is bacterial, and how easy they are to use.
Phase two will then evaluate the most effective of these tests in the management of patients with sore throats. The RADT will be compared to a clinical prediction rule, the Centro criteria, which uses four main symptoms to diagnose a sore throat caused by bacteria (fever, pus on the tonsils, large lymph nodes, and the absence of a cough) and the strategy of delayed prescribing (where an antibiotic can be collected if symptoms are not settling in a few days).
"It is in both the national and international interest to reduce antibiotic consumption to minimise the public health dangers of antibiotic resistance," says Professor Paul Little. "The key to reducing antibiotic use is to be able to identify those patients that will not benefit, but not deny antibiotics to those who will gain significant clinical benefit. RADTs may provide GPs with the support they need to do this quickly and accurately, but it is vital that research is carried out to establish whether this is the case."
For more details about the 'PRImary care Streptococcal Management study (PRISM),' visit http://www.hta.ac.uk/project.asp?PjtId=1534
Notes to Editors
1. The HTA programme produces high quality research information about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. This is a programme of the National Institute for Health Research (www.nihr.ac.uk) and is the largest and longest running of the national programmes with 330 projects published since its inception in 1993. About 50 are published each year, all available for download free of charge from the website. It is coordinated by the National Coordinating Centre for Health Technology Assessment (NCCHTA), based at the University of Southampton. Visit www.hta.ac.uk for more information.
2. Cost of the trial £949,812