The importance of rapid antigen testing for group a streptococcal tonsillopharyngitis: A single center experience

Abstract

Objective: Acute tonsillopharyngitis is one of the most common cause of admission to the pediatric emergency departments. Most of the acute tonsillopharyngitis is due to viral causes and 20-30% is bacterial origin. Bacterial agents are most commonly group A beta-hemolytic streptococcus (GAS). Diagnosis of GAS tonsillopharyngitis is accelerated by the use of rapid antigen detection test (RADT) as well as the gold standard is throat culture. We planned our study to share our clinical experience in GAS tonsillopharyngitis and to discuss the benefits of RADT in the context of the literature. Material and Methods: We retrospectively reviewed the patients between the ages of 1 month and 18 years who were diagnosed acute tonsillopharyngitis between November 2014 and April 2018 in our hospital. Patients’ ages, genders, RADT and throat culture results and also received treatments were recorded. Results: In our pediatric emergency department, during 46 month period RADTs and throat cultures were taken from 22.445 patients which considered bacterial tonsillopharyngitis. 24.9% (n: 5591) of the sample were GAS positive. The mean age of the patients was 8.3 ± 3.22 years and 44.4% (n: 2487) were girls. RADT was positive in 98.5% (n: 5511) of patients infected with GAS and 1.4% (n: 80) of RADT was negative but throat culture was positive and antibiotherapy was applied. In 1.4% (n: 316) of the patients who underwent throat swabs, throat culture was negative while RADT was positive. In this group of patients, RADT was considered to be false positive. Conclusion: Application of antibiotherapy to unproven acute tonsillopharyngitis cases with bacterial etiology increases antibiotic resistance. The clinic should be supported by diagnostic laboratory methods in patients who are compatible with bacterial tonsillopharyngitis to prevent the misuse of unnecessary antibiotics. The widespread use of RADTs with higher sensitivity and specificity rates, which produce faster results than throat cultures, will greatly contribute to the rational use of antibiotics.