The question of the optimal strategy for the diagnosis and management of adult patients with acute pharyngitis remains unresolved. Thus, up to 73% of patients with this pathology receive antibacterial treatment, although the frequency of the bacterial etiology of the infectious process (mainly Streptococcus pyogenes), according to the literature, does not exceed 10%. A cultural standard is considered the gold standard for the diagnosis of strep throat, however, it takes time and greatly increases the cost of patient management. One of the alternative methods of examination is a rapid test for the detection of streptococcal antigen, but its effectiveness has not been sufficiently studied.

In a prospective cohort study by J.P. Humair et al. (Switzerland), included data from 372 adult patients with pharyngitis. All patients were divided into 5 subgroups according to the management strategy:

During the study, the sensitivity and specificity of the rapid streptococcal antigen test were evaluated, as well as a cost-effectiveness analysis when using this method in adult patients with pharyngitis.

According to the results, the rapid test for streptococcal antigen was highly sensitive (91%) and specific (95%) in the diagnosis of streptococcal pharyngitis. The study of a culture of a smear from the pharyngeal mucosa on all patients was accompanied by a frequency of prescription justified at 100% of antibiotics, but it was the most costly strategy economically (32 $ 4 for an episode of an adequately treated infection). Performing an express test for all patients was the second most accurate diagnostic strategy and was accompanied by a slight decrease in the frequency of justified administration of antibacterial drugs (93.8%) with a significant reduction in costs. ($ 15.3 per episode of an adequately treated infection). The use of other patient management strategies has been accompanied by a marked decrease in the frequency of justified antibiotic therapy, with the exception of the strategy of using only symptomatic agents, and higher costs compared to the systematic and rapid test execution strategy.

Thus, the clinical approach to the management of adult patients with acute pharyngitis, based on the systematic implementation of the rapid test for the detection of streptococcal antigen and the appointment of antibiotic therapy only with its positive result, is the most effective from an economic point of view, allowing to limit the unjustified prescription of antibiotics for patients suffering from this pathology.