The Impact of Point-of-Care Testing for Group A Streptococcal Pharyngitis on Antibiotic Prescribing and Patient Health Outcomes in Outpatient Care: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND

Point-of-care testing (POCT) for group A β-hemolytic Streptococcus (StrepA) allows for rapid testing for streptococcal infection in patients with signs of pharyngitis. We conducted a systematic review and meta-analysis of the impact of StrepA POCTs on antibiotic prescribing and health outcomes in patients with signs of pharyngitis in outpatient care.

METHODS

Medline, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs; January 2000-January 2025). Random-effects models were used to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs) for summary effect sizes.

RESULTS

From 15 097 unique records, we identified 8 eligible RCTs comparing the use of StrepA POCTs with standard care. The use of StrepA POCTs reduced the number of antibiotics prescribed by 38% (RR, 0.62 [95% CI, .51-.77]; P < .001). In studies with StrepA POCTs as the sole intervention, antibiotic prescribing was reduced by 41% (RR, 0.59 [95% CI, .44-.78]; P < .001; 5 RCTs). The reduction in antibiotic prescribing was observed in children (RR, 0.56 [95% CI, .39-.81]; P = .002; 4 RCTs) and adults (RR, 0.57 [95% CI, .39-.85]; P = .006; 2 RCTs). The number of follow-up healthcare visits did not differ between StrepA POCT and standard care (RR, 0.56 [95% CI, .29-1.09]; P = .086, 3 RCTs). There were no differences between point estimates of individual RCTs for other patient health outcomes, such as days until pain resolution and days of school/work missed.

CONCLUSIONS

The use of StrepA POCTs in children and adults with signs of pharyngitis likely reduces the number of antibiotics prescribed without compromising patient health outcomes.