Impact of rapid antigen detection testing on antibiotic prescription in acute pharyngitis in adults: FARINGOCAT STUDY: a multicentric randomized controlled trial

Dolor de garganta; Otitis media aguda; Prescripción de antibióticosSore throat; Acute otitis medium; Antibiotic prescriptionMal de gola; Otitis mitjana aguda; Prescripció d'antibiòticsBackground: Acute pharyngitis is one of the most frequent consultations to the general practitioner and in most of the cases an antibiotic is prescribed in primary care in Spain. Bacterial etiology, mainly by group A beta-hemolytic streptococcus (GABHS), accounts for 10-20% of all these infections in adults. The purpose of this study is to assess the impact of rapid antigen detection testing (RADT) to identify GABHS in acute pharyngitis on the utilization of antibiotics in primary care. Methods/design: Multicentric randomized controlled trial in which antibiotic prescription between two groups of patients with acute pharyngitis will be compared. The trial will include two arms, a control and an intervention group in which RADT will be performed. The primary outcome measure will be the proportion of inappropriate antibiotic prescription in each group. Two hundred seventy-six patients are required to detect a reduction in antibiotic prescription from 85% in the control group to 75% in the intervention group with a power of 90% and a level of significance of 5%. Secondary outcome measures will be specific antibiotic treatment, antibiotic resistance rates, secondary effects, days without working, medical visits during the first month and patient satisfaction. Discussion: The implementation of RADT would allow a more rational use of antibiotics and would prevent adverse effects of antibiotics, emergence of antibiotic resistance and the growth of inefficient health expenses.The study is funded by the Fondo de Investigaciones Sanitarias, theUniversity and Innovation Department of Spain (Reference number:PI061782), and from the Catalan Society of Family Medicin

Efficacy and safety of discontinuing antibiotic treatment for uncomplicated respiratory tract infections when deemed unnecessary. A multicentre, randomized clinical trial in primary care

Antibacterial agent; Antibiotic stewardship; Primary health careAgente antibacteriano; Administración de antibióticos; Atención primaria de saludAgent antibacterià; Administració d'antibiòtics; Atenció primària de salutObjectives To determine the benefits and harms of discontinuing unnecessary antibiotic therapy for uncomplicated respiratory tract infections (RTI) when antibiotics are considered no longer necessary. Methods Multicentre, open-label, randomized controlled clinical trial in primary care centres from 2017 to 2020 (ClinicalTrials.gov, NCT02900820). Adults with RTIs—acute rhinosinusitis, sore throat, influenza or acute bronchitis—who had previously taken any dose of antibiotic for less than 3 days, which physicians no longer deemed necessary were recruited. The patients were randomly assigned in a 1:1 ratio to discontinuing antibiotic therapy or the usual strategy of continuing antibiotic treatment. The primary outcome was the duration of severe symptoms (number of days scoring 5 or 6 on a six-item Likert scale). Secondary outcomes included days with symptoms, moderate symptoms (scores of 3 or 4), antibiotics taken, adverse events, patient satisfaction and complications within the first 3 months. Results A total of 467 patients were randomized, out of which 409 were considered valid for the analysis. The mean (SD) duration of severe symptoms was 3.0 (1.5) days for the patients assigned to discontinuation and 2.8 (1.3) days for those allocated to the control group (mean difference 0.2 days; 95% CI –0.1 to 0.4 days). Patients randomized to the discontinuation group used fewer antibiotics after the baseline visit (52/207 (25.1%) versus 182/202 (90.1%); p 0.001). Patients assigned to antibiotic continuation presented a relative risk of adverse events of 1.47 (95% CI 0.80–2.71), but the need for further health-care contact in the following 3 months was slightly lower (RR 0.61; 95% CI 0.28–1.37). Conclusions Discontinuing antibiotic treatment for uncomplicated RTIs when clinicians consider it unnecessary is safe and notably reduces antibiotic consumption.This work was supported by the Catalan Society of Family Medicine, grant number FAP1601. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. This trial was registered with the ClinicalTrials.gov database (Identifier: NCT02900820)

The STOP-AB trial protocol: efficacy and safety of discontinuing patient antibiotic treatment when physicians no longer consider it necessary

Desde 2011, la Sociedad Española de Medicina Familiar ha recomendado a los médicos de cabecera que pidan a sus pacientes que dejen de tomar antibióticos cuando sospechen una infección viral. El objetivo principal de este estudio es determinar si la interrupción del tratamiento con antibióticos cuando un médico de cabecera ya no lo considera necesario tiene algún impacto en el número de días con síntomas graves. Se realiza un ensayo clínico controlado aleatorizado, multicéntrico y abierto. El estudio se realizó en 10 centros de atención primaria en España. Los pacientes fueron asignados aleatoriamente a la estrategia habitual de continuar el tratamiento con antibióticos o suspender el tratamiento con antibióticos. Se calculó un tamaño de muestra de 240 pacientes por grupo sobre la base de una reducción de 1 día en la duración de los síntomas graves es un resultado clínicamente relevante. El resultado primario fue la duración de los síntomas graves, es decir, los síntomas puntuados 5 o 6 por medio de diarios de síntomas validados. Los resultados secundarios incluyeron antibióticos tomados, eventos adversos, satisfacción del paciente y complicaciones dentro de los primeros 3 meses.Since 2011, the Spanish Society of Family Medicine has recommended to GPs that focus on their patients to stop taking antibiotics when they suspect a viral infection. The main objective of this study is to determine whether interrupting antibiotic treatment when a GP is no longer considered necessary has an impact on the number of days with severe symptoms. A randomized, multicenter and open controlled clinical trial is carried out. The study was carried out in 10 primary care centers in Spain. The patients were randomly assigned to the usual strategy of continuing antibiotic treatment or discontinuing antibiotic treatment. A sample size of 240 patients per group is calculated based on a 1-day reduction in the duration of the sequential session is a clinically relevant result. The primary outcome was the duration of the severe symptoms, that is, the specific symptoms 5 or 6 by means of validated symptoms. The results include antibiotics taken, adverse events, patient satisfaction and difficulties within the first 3 mon