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Arch Pediatr. 2014 Nov;21 Suppl 2:S78-83. doi: 10.1016/S0929-693X(14)72265-1. Epub 2014 Nov 13.

[Rapid antigen detection tests for group A streptococcus in children with pharyngitis].

[Article in French]

Author information

1
Service de pédiatrie générale, hôpital Necker-enfants malades, 149, rue de Sèvres, 75015 Paris, France; INSERM, UMR 1153, équipe de recherche en épidémiologie périnatale, obstétricale et pédiatrique (EPOPE), centre de recherche épidémiologie et statistique, Sorbonne-Paris-Cité (CRESS), 53, avenue de l'Observatoire, 75014 Paris, France; Université Paris-Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France. Electronic address: jeremie.cohen@inserm.fr.
2
ACTIV (Association clinique et thérapeutique infantile du Val-de-Marne), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France; Centre de recherche clinique (CRC) et Centre hospitalier intercommunal (CHI), 40, avenue de Verdun, 94010 Créteil, France; AFPA (Association française de pédiatrie ambulatoire), 4, rue Parmentier, 54270 Essey-les-Nancy, France.
3
Service de pédiatrie générale, hôpital Necker-enfants malades, 149, rue de Sèvres, 75015 Paris, France; INSERM, UMR 1153, équipe de recherche en épidémiologie périnatale, obstétricale et pédiatrique (EPOPE), centre de recherche épidémiologie et statistique, Sorbonne-Paris-Cité (CRESS), 53, avenue de l'Observatoire, 75014 Paris, France; Université Paris-Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
4
Service de microbiologie, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Université Paris-Diderot, PRES Sorbonne-Paris-Cité, 46, rue Henri-Huchard, 75018 Paris, France.
5
ACTIV (Association clinique et thérapeutique infantile du Val-de-Marne), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France; Centre de recherche clinique (CRC) et Centre hospitalier intercommunal (CHI), 40, avenue de Verdun, 94010 Créteil, France; AFPA (Association française de pédiatrie ambulatoire), 4, rue Parmentier, 54270 Essey-les-Nancy, France; Unité court séjour, petits nourrissons, service de néonatologie, CHI de Créteil, 40, avenue de Verdun, 94010 Créteil, France.

Abstract

Group A streptococcus (GAS) is the most frequently identified bacterium in children with acute pharyngitis. Clinical signs and symptoms cannot distinguish accurately between viral and GAS pharyngitis. Rapid antigen detection tests (RADTs) can identify GAS by an immunologic reaction within a few minutes. Compared to throat culture, most RADTs have a high specificity (around 95 %), allowing antibiotic prescribing on the basis of a positive RADT result. Similarly, the negative predictive value of RADTs seems sufficiently high (around 95 %) to ensure against the presence of GAS in case of a negative RADT result. Among several factors affecting RADT sensitivity, the training and expertise of the person performing the test and the quality of the throat swab specimen seem to be key determinants. Available evidence suggests that clinical prediction rules for the triage of children who should undergo GAS testing are not sufficiently accurate. Implementing RADTs into clinical practice has an important impact on antibiotic prescription rates, for a reduction of about 30 %. French guidelines that recommend using RADTs in all children above 3 years of age presenting with pharyngitis without backup culture of negative tests seem relevant in this context.

PMID:
25456685
DOI:
10.1016/S0929-693X(14)72265-1
[Indexed for MEDLINE]

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