Rapid antigen detecting tests
Topic Status Complete
Rapid antigen detecting tests for diagnosing group A streptococcal infections in the community pharmacy setting.
Outcome of the appraisal
The use of rapid antigen detection tests (RADT) within the community pharmacy setting for the diagnosis and management of people with group A streptococcal infections is promising. Nonetheless, the current evidence is limited and does not support routine adoption.
Uncertainties remain about the clinical and cost effectiveness of the use RADT in all clinical settings. Some promising evidence has been collected on the use of RADTs in community pharmacies in Wales as part of a pilot of the NHS Wales Sore Throat Test and Treat Service but more definitive studies are required. HTW would support the accumulation of this new evidence in the setting of NHS Wales.
Further research is recommended to demonstrate the clinical effectiveness of RADT in the community pharmacy setting.
Why was this topic appraised?
Most cases of sore throat resolve without the need for antibiotic treatment, but a minority of cases are caused by bacterial infections (most commonly group A streptococcal infections) that may benefit from antibiotics. Rapid antigen detection tests (RADTs) are point-of-care tests that have been postulated for use in primary care to help diagnose cases of sore throat caused by group A streptococcal infections and guide antibiotic prescribing decisions.
The topic proposer requested that HTW assess the use of this test specifically in the community pharmacy setting since, if clinically and cost effective, the use of RADTs in this way may alleviate pressure on General Practices and improve the stewardship of appropriate antibiotic prescribing. This topic was submitted to Health Technology Wales by Andrew Evans, Chief Pharmaceutical Officer, Welsh Government.
Plain language summary
A sore throat describes the symptom of pain at the back of the mouth. There are many illness that can cause a sore throat, some more serious than others. For mild cases, a sore throat may resolve itself within a week. However, an acutely sore throat can come with other symptoms such as pain, fever, headache, nausea, vomiting, abdominal pain, muscle pain and rashes. Sore throat is most often caused by viral infection, while bacterial infections and non-infectious causes, such as hay fever and chronic cigarette smoke, are less common. The most common bacterial infection cause of sore throat is group A beta-haemolytic streptococcus (GABHS), which is treated with antibiotics. However, these would not be effective for a viral infection. Distinguishing between bacterial and viral infections in order to know what treatment to give can be difficult due to the similarity of symptoms.
Currently, best practice for testing for the presence of GABHS is to take a throat swab from the patient which is sent away to a laboratory to test for the presence of the bacteria. Rapid antigen detection tests (RADT) were developed to provide an immediate test result while the healthcare professional is still with the patient. This test does not need to be sent away to a laboratory, making it a quicker way to determine if the sore throat is caused by a bacterial or viral infection.
Health Technology Wales (HTW) looked for evidence of the effectiveness of RADT for diagnosing and managing suspected Group A Streptococcal infection in the community pharmacy setting. There was limited evidence currently available on the use of RADT and its effectiveness in diagnosing GABHS in the community pharmacy setting. However, there is a demand for this service in Wales and where it is being put into practice it would be beneficial to encourage studies. A de novo health economic analysis found RADT in the community pharmacy setting to be cost-effective.
HTW Guidance states that the use of rapid antigen detection tests (RADT) within the community pharmacy setting for the diagnosis and management of people with group A streptococcal infections is promising. Nonetheless, the current evidence is limited and does not support routine adoption