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Point of Care Strep Tests Speed Treatment, Lower Costs


Beta-hemolytic group A streptococcus (S. pyogenes) is the most common bacterial agent associated with upper respiratory tract infections. Although it usually involves mild symptoms (such as headache, fever or abdominal pain) if left untreated streptococcal infection can worsen and become life-threatening. Early diagnosis and treatment of group A streptococcal pharyngitis has been shown to reduce the severity of symptoms and further complications such as rheumatic fever and glomerulonephritis. Given the risks, physicians often rely on a presumptive clinical diagnosis.

The conventional methods used to confirm group A streptococcal infection depend on the isolation and identification of the organism on blood agar plates. These methods usually require 18-24 hours of incubation at 37C. This delay in identifying group A streptococcus has often caused physicians to administer therapy without first knowing the etiological agent. Alternatively, the development of the rapid antigen detection test (RADT) has allowed the identification of group A streptococcal carbohydrate on a throat swab in a matter of minutes.

This prompt, point-of-care test has proven a valuable resource in the office management of patients with pharyngitis. RADT has improved the appropriateness of antibiotic therapy and allowed earlier laboratory, evidence-based treatment of group A -hemolytic streptococcal pharyngitis.

Despite the widespread use and broadly demonstrated accuracy of rapid testing, some controversy remains in the clinical community about the need for agar incubation culture as a confirmatory procedure following a positive RADT and prior to the initiation of antibiotic therapy or as a reassay in those instances when RADT results are negative yet clinical findings support a diagnosis of Strep-A infection. In such instances, the perceived need for dual testing can actually increase the overall cost of diagnosis. On balance, however, RADT appears to have accelerate
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