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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




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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