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Journal Article

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Little, P., Hobbs, F. D. R., Moore, M., Mant, D., Williamson, I., McNulty, C., Lasseter, G., Cheng, Y.E., Leydon, G., Leydon, G., McDermott, L., Turner, D., Pinedo-Villanueva, R., Raftery, J., Glasziou, P., & Mullee, P. (2014). PRImary care streptococcal management (PRISM) study: In vitro study, diagnostic cohorts and a pragmatic adaptive randomised controlled trial with nested qualitative study and cost-effectiveness study. Health Technology Assessment ,18(6), 1-8.

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2014 HERDC Submission




The overuse of antibiotics in primary care not only increases the risk of antibiotic resistance but exposes patients to side effects, and medicalises what are mostly self-limiting illnesses. Antibiotics are still prescribed for most patients attending primary care with acute sore throat, despite evidence from systematic reviews that there is modest benefit overall from antibiotics. Approaches to targeting antibiotics could facilitate more appropriate use of antibiotics, either targeting antibiotics using clinical scoring methods or using rapid antigen detection tests (RADTs). RADTs are very commonly used in many countries and are designed to detect the major bacterial pathogen Lancefield group A beta-haemolytic streptococcus (GABHS). However, there is debate about the importance of other major groups of streptococci (particularly Lancefield groups C and G). Furthermore, there is uncertainty about the variables that most clearly predict the presence of streptococci, and about the most appropriate RADTs to use in primary care. There is also very little robust trial evidence comparing management alternatives.



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