Introduction
Pharyngitis, sore throat, throat, GAS pharyngitis, pharyngitis, beta-hemolytic streptococci, strep
PHARYNGITIS, PHARYNGITIS, SORE THROAT
Pharyngitis due to Group A beta-hemolytic streptococci (GAS) is traditionally seen as the main indication for antibiotics for sore throat. Irrespective of the presence of GAS, the natural course of a sore throat in patients presenting in primary care is generally good, and it is only moderately shortened by antibiotics, slightly more in case of a throat swab positive for GAS [Symptoms and signs of GAS pharyngitis are rather unspecific [The culture of a throat swab for GAS is time consuming, but still the gold standard for the diagnosis of GAS pharyngitis. Rapid strep tests (RADTs = Rapid antigen detection tests for GAS) as point-of-care tests deliver a quick result in the office [In high-income countries the mean GAS prevalence in patients with pharyngitis is about 25% [Few trials have studied the influence of diagnostic tools like clinical scores and/or RADTs on antibiotic prescriptions and patient outcomes in daily practice. While the sole use of scores failed to reduce prescriptions [Recommendations in international guidelines differ considerably. They cover the full range from a pure clinical approach to demanding a positive rapid test and/or culture for GAS before prescribing an antibiotic [We hypothesized that the active implementation of the guideline would lower the prescription rate, and that an additional RADT in all patients with scores ≥ 3 and suggesting antibiotic prescriptions only to patients with a positive test for GAS would lower the rate further. We expected that both strategies would have no effect on patient outcomes.