Implementation of molecular diagnostic testing for group A streptococcal pharyngitis: considerations and challenges with a focus on point-of-care environments

Abstract

Introduction: Rapid and accurate detection of group A streptococcus (GAS) pharyngitis allows for timely initiation of appropriate antibiotic treatment. This is important to prevent empiric antibiotic overuse while simultaneously lowering the risk of post-infection sequelae. Timely treatment may also reduce forward transmission, which could prevent cases of devastating invasive infections. The need for timely and accurate diagnosis of GAS pharyngitis has created an ideal environment for molecular diagnostic (MDx) testing. The high sensitivity of MDx tests mean no culture confirmation is required for negative results in most situations, and several MDx tests are approved for point-of-care (PoC) use. As such, MDx technology can lower the barriers to treatment in remote areas of high incidence, where resources are limited. We believe it is time for widespread adoption of MDx testing for GAS pharyngitis. Areas Covered: Here, we highlight the advantages of MDx GAS pharyngitis testing and discuss challenges to implementation–as well as solutions to these challenges. Expert Opinion: In the face of increased GAS-induced disease following the end of the COVID-19 pandemic, evidence supporting the clinical validity and cost-effectiveness of MDx testing for GAS pharyngitis continues to grow. Although hurdles to implementation exist, broad-based implementation of this technology is within practical reach.