[Impact of a antimicrobial stewardship in the community on optimizing the treatment of streptococcal pharyngotonsillitis: a before-and-after intervention study].

OBJECTIVE

To evaluate whether the antibiotic treatment of acute bacterial pharyngitis has improved following the implementation and intervention of community antimicrobial stewardship.

MATERIAL AND

METHODS

An observational before-after study was conducted. The study included patients who underwent a rapid antigen detection test for Streptococcus pyogenes in Primary Care, with results documented in electronic health records. Test registration data and antibiotic treatments prescribed within five days of testing were compared across two respiratory infection seasons separated by a four-year interval (October 2019 - March 2020 and October 2022 - March 2023). Between both periods, the community antimicrobial stewardship provided training sessions to the primary care teams.

RESULTS

Positive results increased from 29.3% in the first season to 40.4% in the second one. Among patients with positive results, penicillin use increased from 49% to 65% of patients, reaching 90% if amoxicillin is included. The use of amoxicillin+clavulanic acid decreased by 47%. The use of other antibiotics that are not first-line therapies for acute bacterial pharyngotonsillitis decreased too (cefuroxime, ciprofloxacin, and levofloxacin).

CONCLUSIONS

The implementation of antimicrobial stewardship programs in primary care in our community significantly improved the treatment of bacterial pharyngotonsillitis, with a higher percentage of cases complying with the National Health System's antimicrobial therapy guidelines.