NICE publishes briefing on primary care-based point-of-care tests for strep A in sore throat

False-colour image of Streptococcus pyogenes

The National Institute for Health and Care Excellence (NICE) has published a medtech innovation briefing on point-of-care diagnostic testing in primary care for group A streptococci
(strep A) in sore throat.

The medtech innovation briefing, designed by NICE to support the NHS and social care commissioners and staff who are considering using new medical devices and other diagnostic technologies, describes 11 technologies for strep A throat infections that could potentially be used in primary care. Nine of the tests are rapid antigen detections tests, and the other two use nucleic acid amplification techniques.

According to the briefing, the intended use for these technologies would be in addition to clinical scoring systems, to increase diagnostic confidence of a suspected strep A infection and guide antibiotic prescribing for people presenting with sore throat in primary care and community pharmacy.

The evidence for the briefing was taken from four prospective studies, one pilot study and a systematic review including 102,694 patients — of whom 3,552 were tested with the technologies described in the briefing. The results from these studies suggest that using point-of-care tests in addition to clinical scoring systems is a more helpful way of diagnosing strep A infection in people with acute sore throat.

The briefing highlights that the resource impact of these technologies would initially be greater than standard care but that this could eventually be offset if their use leads to better antimicrobial stewardship and a reduction in antimicrobial resistance.

In July 2016, a ‘test and treat’ service piloted in Boots pharmacies across London and Leicestershire found that point-of-care testing for strep A in community pharmacy was able to limit antibiotic prescriptions to just 9.8% of patients, and may have reduced unnecessary GP consultations.

Last updated
Citation
The Pharmaceutical Journal, May 2018;Online:DOI:10.1211/PJ.2018.20204793