An Assessment of Rapid Streptococcal Tests in Community Clinics in Israel

This study has been completed.
Sponsor:
Collaborator:
Dept of Family Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel
Information provided by:
Meir Medical Center
ClinicalTrials.gov Identifier:
NCT00535093
First received: September 24, 2007
Last updated: May 2, 2010
Last verified: September 2009

September 24, 2007
May 2, 2010
October 2007
July 2009   (final data collection date for primary outcome measure)
sensitivity of RST specificity of RST [ Time Frame: 3-4 months ] [ Designated as safety issue: No ]
sensitivity of RST specificity of RST [ Time Frame: 3-4 months ]
Complete list of historical versions of study NCT00535093 on ClinicalTrials.gov Archive Site
ease of use effect on antibacterial prescribing [ Time Frame: 3-4 months ] [ Designated as safety issue: No ]
ease of use effect on antibacterial prescribing [ Time Frame: 3-4 months ]
Not Provided
Not Provided
 
An Assessment of Rapid Streptococcal Tests in Community Clinics in Israel
A Comparison of Available Rapid Streptococcus A Tests in Community Clinics in Israel: Accuracy, Ease of Use and Acceptability.

There is a large over-use of antibiotics in family medicine, especially in upper respiratory tract infections.

This study is designed to determine if the use of rapid Streptococcal tests in primary care clinics can lower the rate of antibiotic use while not missing bacterial infections.

Pharyngitis is a clinical diagnosis which requires antibiotic treatment only if caused by group A Streptococcus (GAS).

However, it is impossible to identify by clinical signs alone those patients whose symptoms are caused by this pathogen.

Diagnosis demands a throat culture, which requires at least 24 hours to rule in infection and 48 hours to rule it out.

Rapid Streptococcal tests (RST) based on antigen identification have been in use for over 10 years. These allow determination of the presence of GAS within 10 minutes using tests designed for point of care use.

While the specificity of these tests is generally reported as high (90-95%), the sensitivity is quoted at between 60% and 90% , depending on author affiliation, place of testing and type of test.

Various protocols have been put forward, these combine clinical signs (Centor criteria) with RST or throat cultures in order to lower antibiotic over-use.

These protocols are often under-used by primary physicians, even when RSTs are available.

Clalit health services, the largest HMO in Israel, has decided to evaluate all the RSTs available in the country in community clinic settings in order to determine the feasibility of adopting these tests to improve clinical care.

The sensitivity, specificity and ease-of-use will be assessed in 25 clinics in various settings (urban and rural). Gold standard will be a standard throat culture processed in the district laboratory.

The effect of point-of-care testing will be estimated by requiring physicians to decide on antibiotic use before receiving the result of the RST. (They will be free to change this decision after the test).

Clinics were selected by number of throat cultures sent in previous years. The number of patients was determined using the positivity rates of 2005. The results of this study will enable us to estimate the benefit and cost of adopting RSTs, and to determine in which situations they will be most efficacious.

Interventional
Not Provided
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Diagnostic
  • Pharyngitis
  • Streptococcus Pyogenes Infection
  • Streptococcus Pyogenes Identification
Device: rapid streptococcal testing
Each patient will have both RST and standard throat culture performed. Final diagnosis and treatment will be determined by throat culture
No Intervention: 1
All patients fulfilling inclusion criteria will be evaluated for GAS infection using both a rapid streptococcus test and also a standard throat culture
Intervention: Device: rapid streptococcal testing

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
7000
July 2009
July 2009   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • sore throat
  • at least two Centor criteria:
  • fever > 38 deg C or history of fever
  • enlarged cervical lymph nodes
  • tonsillar exudate
  • lack of cough
  • age 3-14 years

Exclusion Criteria:

  • antibiotic treatment in preceding 7 days
  • no informed consent
Both
3 Years and older
No
Contact information is only displayed when the study is recruiting subjects
Israel
 
NCT00535093
HT4152
No
Ian MiskinMD, Clalit Health Services Jerusalem Israel
Meir Medical Center
Dept of Family Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel
Principal Investigator: Ian N Miskin, MD Clalit Health Services, Jerusalem district
Meir Medical Center
September 2009

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP