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Three Part Question

In [children with tonsillitis], is a [throat swab] [indicated prior to antibiotics]?

Clinical Scenario

A 3 year old boy was brought to the ED because of a fever, sore throat and an inflamed and tender tonsils. Tonsillitis is suspected. Should the treating doctor perform a throat swab first before prescribing antibiotics?

Search Strategy

Ovid MEDLINE(R) 1948 to June Week 3 2011 and
Embase 1980 to 2011 Week 25 and
CINAHL

[tonsillitis.mp. OR exp palatine tonsillitis/ OR exp chronic tonsillitis/ OR exp tonsillitis/]

AND

[throat swab.mp.]

AND

[antibiotics.mp. OR antibiotic*.mp. OR exp Anti-Bacterial Agents/]

limit to (english language and humans and "all child (0 to 18 years)")

Search Outcome

17 papers were found in Medline, 92 in Embase and 5 results obtained from CINAHL.
Only 1 paper was relevant.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Maltezou HC. Tsagris V. Antoniadou A. Galani L. Douros C. Katsarolis I. Maragos A. Raftopoulos V. Bi 4/7/2011 Greece	820 children with streptococcal pharyngitis were enrolled into 3 groups; Group A (enrolment by private-practice paediatrician & diagnosed by clinical picture only), Group B (enrolment by private-practice paediatricians and diagnosed by RADT & culture or Group C (enrolment by hospital-affiliated paediatricians and diagnosed by RADT & culture)	Diagnostic study	To study the performance and validity of RADT for diagnosing streptococcal pharyngitis.	Sensitivity : 83.1%; spesificity: 93.3%; positive predictive value: 82.4% and negative predictive value: 93.6%.	The patients were allocated depending on the participating practices/hospitals they presented to, not each patient individually. Subjects were not all acounted for. Participants were not blinded.

Comment(s)

There is obviously insufficient evidence with regards to this question. However, from the one study included in this BET, it is evident that RADT has a high negative predictive value and specificity which would most likely determine which antibiotic would be most suitable thus avoiding unnecessary medication.

Clinical Bottom Line

Inconclusive due to insufficient evidence.

References

1. Maltezou HC. Tsagris V. Antoniadou A. Galani L. Douros C. Katsarolis I. Maragos A. Raftopoulos V. Biskini P. Kanellakopoulou K. Fretzayas A. Papadimitriou T. Nicolaidou P. Giamarellou H. Evaluation of a rapid antigen detection test in the diagnosis of streptococcal pharyngitis in children and its impact on antibiotic prescription. Journal of Antimicrobial Chemotherapy 2008