Date of this Version

10-10-2013

Document Type

Journal Article

Publication Details

Citation only

Little, P., Richard Hobbs, F. D., Moore, M., Mant, D., Williamson, I., McNulty, C., Cheng, Y.E., Leydon, G., McManus, R., Barnett, J., Glasziou, P., & Mullee, M. (2013). Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: Randomised controlled trial of PRISM (primary care streptococcal management). BMJ (Online), 347(7930).

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© Copyright, The Authors, 2013

This work is licensed under a Creative Commons Attribution 3.0 License

2013 HERDC submission. FoR Code:111717;110399

ISSN

1756-1833

Abstract

Objective To determine the effect of clinical scores that predict streptococcal infection or rapid streptococcal antigen detection tests compared with delayed antibiotic prescribing. Design: Open adaptive pragmatic parallel group randomised controlled trial. Setting: Primary care in United Kingdom. Patients: Patients aged .3 with acute sore throat. Intervention: An internet programme randomised patients to targeted antibiotic use according to: delayed antibiotics (the comparator group for analyses), clinical score, or antigen test used according to clinical score. During the trial a preliminary streptococcal score (score 1, n=1129) was replaced by a more consistent score (score 2, n=631; features: fever during previous 24 hours; purulence; attends rapidly (within three days after onset of symptoms); inflamed tonsils; no cough/coryza (acronym FeverPAIN). Outcomes: Symptom severity reported by patients on a 7 point Likert scale (mean severity of sore throat/difficulty swallowing for days two to four after the consultation (primary outcome), duration of symptoms, use of antibiotics.

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