Introduction: Pharyngitis is a common condition in pediatric patients, accounting for about 2-5% of outpatient visits. Although most cases are viral, 15-30% in children are bacterial, primarily caused by Streptococcus pyogenes. Despite this, around 60% of children with pharyngitis receive antibiotics. This inappropriate antibiotic use has contributed to increasing antimicrobial resistance. To combat this threat, diagnostic and antibiotic stewardship programs have been developed and implemented to improve diagnosis and prescription accuracy. The rapid antigen detection test (RADT) for streptococcus is a useful point-of-care test for identifying bacterial pharyngitis in children, the only cases where antibiotic treatment is recommended, thereby enhancing the appropriateness of therapy. Objective: The study aims to evaluate the impact of introducing RADT on antibiotic prescriptions in children with pharyngitis by analyzing the changes in antibiotic prescribing patterns before and after the implementation of the tests. Materials and Methods: A case-control study was conducted using data collected through Pedianet between 2010 and 2023, evaluating antibiotic prescriptions in the year before and after the implementation of RADT. Results: The study included 13 Italian pediatricians who implemented RADT, matched with 24 pediatricians who did not implement the test during the considered period, using 1:1 to 1:3 matching. This included a total of 3583 children with pharyngitis among the cases (1571 pre- and 2,12 post-implementation) and 5000 among the controls (2545 pre- and 2455 post-implementation). The implementation of RADT among the cases led to a statistically significant reduction in antibiotic prescriptions, decreasing from 68.6% to 64.2% of total pharyngitis diagnoses (p-value 0.005). A slight reduction in prescriptions was also recorded among the controls. However, the percentage of episodes treated with antibiotics remains high compared to the estimated frequency of bacterial pharyngitis There were no significant changes regarding the type of antibiotic prescribed. Amoxicillin, the first-line drug, was prescribed in about 20% of cases. The most prescribed antibiotic remained amoxicillin-clavulanic acid, both pre- and post-implementation, among cases and controls. However, a reduction in its use was observed in the post-implementation group among controls, with a concurrent increase in the use of cephalosporins. Conclusions: The introduction of RADTs has led to a reduction in antibiotic prescriptions in children with pharyngotonsillitis; however, the percentage of cases treated with antibiotics remains high compared to the incidence of bacterial pharyngotonsillitis. The inadequate choice of first-line molecule remains a significant problem. Despite the use of RADTs, prescriptions for amoxicillin-clavulanic acid and second- and third-generation cephalosporins remain high, while amoxicillin is chosen as the first-line molecule in only 20% of cases. The use of RADTs alone is therefore not sufficient to improve antibiotic prescriptions. Further measures and actions are necessary to improve patient management, including educational strategies at the local level.
Introduzione: La faringotonsillite è una patologia ad elevata incidenza in età pediatrica. Si stima infatti che rappresenti la causa di circa il 2-5% delle visite ambulatoriali. Sebbene la maggior parte di questi casi abbia un’eziologia virale, nella popolazione pediatrica il 15-30% risulta di origine batterica, in particolare da Streptococcus pyogenes. Nonostante ciò, circa il 60% dei bambini con faringotonsillite viene sottoposto ad un trattamento antibiotico. L’uso inappropriato di antibiotici ha contribuito nel tempo all’aumento della resistenza antimicrobica. Per fronteggiare tale minaccia, sono stati introdotti i programmi di stewardship diagnostica e antibiotica, con lo scopo di migliorare la diagnosi e l’appropriatezza delle prescrizioni. Il test rapido per lo streptococco (RADT) rappresenta un point-of-care test utile per aiutare nella diagnosi eziologica delle faringotonsilliti batteriche in età pediatrica, le uniche per le quali è raccomandato un trattamento antibiotico, migliorando così di conseguenza l’appropriatezza della terapia prescritta. Scopo: L’obiettivo dello studio è valutare l’impatto dell’introduzione dei RADT sulle prescrizioni di antibiotici nei bambini con faringite, analizzando i cambiamenti nella prescrizione di antibiotici pre e post-implementazione dei test. Materiali e metodi: È stato condotto uno studio caso-controllo utilizzando dati raccolti attraverso il database Pedianet nel periodo tra il 2010 e il 2023, valutando le prescrizioni di antibiotici nell’anno precedente e successivo all’implementazione dei RADT. Risultati: sono stati inclusi nello studio 13 pediatri di base italiani che hanno implementato il RADT abbinati a 24 pediatri di base italiani che non avevano implementato il test nel periodo considerato per il match (abbinamento 1:1 – 1:3), per un totale di 3583 bambini con faringotonsilliti tra i casi (1571 pre e 2012 post) e 5000 tra i controlli (2545 pre e 2455 post). L’implementazione del RADT tra i casi ha portato ad una riduzione statisticamente significativa delle prescrizioni di antibiotici, passando dal 68.6% al 64.2% rispetto al totale delle diagnosi di faringotonsillite (p-value 0.005). Una lieve riduzione nella prescrizione si è registrata anche tra i controlli. La percentuale di episodi trattata con antibiotico rimane tuttavia elevata rispetto alla stima della frequenza di faringotonsilliti batteriche. Non si sono osservate grandi variazioni per quanto riguarda il tipo di antibiotico prescritto. L’amoxicillina, farmaco di prima linea, viene prescritto in circa il 20% dei casi, mentre l’antibiotico maggiormente prescritto risulta essere l’amoxicillina-acido clavulanico, sia pre che post implementazione, sia tra i casi che tra i controlli, seppur in quest’ultimo gruppo si registri una riduzione del suo uso nel gruppo post con un contestuale aumento nell’uso delle cefalosporine. Conclusioni: L’introduzione dei RADT ha portato ad una riduzione delle prescrizioni di antibiotici nei bambini con faringotonsillite, tuttavia la percentuale di casi trattati con antibiotici rimane ancora alta rispetto all’incidenza di faringotonsillite batterica. La scelta inadeguata della molecola di prima linea rimane un problema significativo. Nonostante l'uso di RADT, le prescrizioni di amoxicillina acido clavulanico e cefalosporine di II e III generazione sono rimaste elevate, mentre l'amoxicillina viene scelta come molecola di prima linea solo nel 20% dei casi. L'uso dei RADT da solo non è sufficiente, pertanto, a migliorare le prescrizioni di antibiotici. Ulteriori misure e azioni sono necessarie per migliorare la gestione dei pazienti, includendo strategie educative anche a livello territoriale.
Valutazione dell'impatto del test rapido per streptococco sulla prescrizione di antibiotici nei bambini con faringotonsillite nel setting ambulatoriale in Italia: uno studio di popolazione caso-controllo
SKLODOWSKA, GLORIA
2023/2024
Abstract
Introduction: Pharyngitis is a common condition in pediatric patients, accounting for about 2-5% of outpatient visits. Although most cases are viral, 15-30% in children are bacterial, primarily caused by Streptococcus pyogenes. Despite this, around 60% of children with pharyngitis receive antibiotics. This inappropriate antibiotic use has contributed to increasing antimicrobial resistance. To combat this threat, diagnostic and antibiotic stewardship programs have been developed and implemented to improve diagnosis and prescription accuracy. The rapid antigen detection test (RADT) for streptococcus is a useful point-of-care test for identifying bacterial pharyngitis in children, the only cases where antibiotic treatment is recommended, thereby enhancing the appropriateness of therapy. Objective: The study aims to evaluate the impact of introducing RADT on antibiotic prescriptions in children with pharyngitis by analyzing the changes in antibiotic prescribing patterns before and after the implementation of the tests. Materials and Methods: A case-control study was conducted using data collected through Pedianet between 2010 and 2023, evaluating antibiotic prescriptions in the year before and after the implementation of RADT. Results: The study included 13 Italian pediatricians who implemented RADT, matched with 24 pediatricians who did not implement the test during the considered period, using 1:1 to 1:3 matching. This included a total of 3583 children with pharyngitis among the cases (1571 pre- and 2,12 post-implementation) and 5000 among the controls (2545 pre- and 2455 post-implementation). The implementation of RADT among the cases led to a statistically significant reduction in antibiotic prescriptions, decreasing from 68.6% to 64.2% of total pharyngitis diagnoses (p-value 0.005). A slight reduction in prescriptions was also recorded among the controls. However, the percentage of episodes treated with antibiotics remains high compared to the estimated frequency of bacterial pharyngitis There were no significant changes regarding the type of antibiotic prescribed. Amoxicillin, the first-line drug, was prescribed in about 20% of cases. The most prescribed antibiotic remained amoxicillin-clavulanic acid, both pre- and post-implementation, among cases and controls. However, a reduction in its use was observed in the post-implementation group among controls, with a concurrent increase in the use of cephalosporins. Conclusions: The introduction of RADTs has led to a reduction in antibiotic prescriptions in children with pharyngotonsillitis; however, the percentage of cases treated with antibiotics remains high compared to the incidence of bacterial pharyngotonsillitis. The inadequate choice of first-line molecule remains a significant problem. Despite the use of RADTs, prescriptions for amoxicillin-clavulanic acid and second- and third-generation cephalosporins remain high, while amoxicillin is chosen as the first-line molecule in only 20% of cases. The use of RADTs alone is therefore not sufficient to improve antibiotic prescriptions. Further measures and actions are necessary to improve patient management, including educational strategies at the local level.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/65756