Antibiotics Not Recommended in Pediatrics With Negative Rapid Strep Test Results

A recent clinical review reported in the Annals of Emergency Medicine concluded that pediatric patients with group A streptococcal pharyngitis (strep throat) should not be treated with antibiotics if the results of a rapid antigen detection test (RADT) are negative.

With current concerns that antibiotics are being overused, whether or not to treat strep throat in children with antibiotics poses a dilemma for clinicians. While strep can lead to serious complications, including rheumatic fever, rheumatic fever is declining worldwide, and more than half of pediatric patients will have a viral infection rather than a bacterial one.

Latha Ganti, MD, MBA, and Bethany L. Ballinger, MBBS, AFRCSEd, both from the department of clinical sciences at University of Central Florida College of Medicine in Orlando, reviewed 105 studies that reported on the accuracy of enzyme immunoassay and optical immunoassay RADT for strep. 

A total of 58,244 patients under age 21 who were treated for sore throat at clinics and emergency departments from 1980 through June 2013 were included in the study.

Drs Gantri and Ballinger found that the sensitivity of RADT ranged from 82.7% to 89.7% and specificity ranged from 91.5% to 96.6%. With a less than 5% chance that a negative RADT result will miss strep, Drs Gantri and Ballinger concluded that children with negative RADT results do not need antibiotics. They also concluded that further testing, such as a throat culture, as called for by the 2012 Infectious Diseases Society of America guidelines when RADT is negative, is not necessary.

Reference

Ganti L, Ballinger BL. How accurate if rapid antigen testing for group A streptococcus in children with pharyngitis? [published online August 31, 2017] Ann Emerg Med. doi:10:1016/j.annemergmed.2017.07.018