Association between rapid antigen detection tests and antibiotics for acute pharyngitis in Japan: A retrospective observational study

Yusuke Teratani, Hideharu Hagiya, Toshihiro Koyama, Ayako Ohshima, Yoshito Zamami, Yasuhisa Tatebe, Ken Tasaka, Kazuaki Shinomiya, Yoshihisa Kitamura, Toshiaki Sendo, Shiro Hinotsu, Mitsunobu R. Kano

Research output: Contribution to journalArticle

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Abstract

The application and clinical impact of rapid antigen detection test (RADT) in the treatment of acute pharyngitis is unknown in Japan. We aimed to examine the proportions of RADT usage to identify Group A β-hemolytic Streptococcus (GAS) in outpatients with acute pharyngitis and evaluate the association between RADT and antibiotic treatment. We analyzed health insurance claims data from 2013 to 2015. Logistic regression models were used to analyze associated factors with RADT, overall antibiotic prescription, or penicillin use. We analyzed 1.27 million outpatient visits with acute pharyngitis, in which antibiotics were prescribed in 59.3% of visits. Of the total visits, 5.6% of patients received RADT, and 10.8% of the antibiotics were penicillin. Penicillin selection rates were higher in cases with RADT (25.4%) than those without RADT (9.7%). Compared to large-scale facilities, antibiotic prescription rates were higher in physicians’ offices. For factor analysis, age (3–15 years), diagnosis code (streptococcal pharyngitis), size of the medical facility (large-scale hospitals), and physician's specialty (pediatrics) were associated with RADT use. Penicillin selection rate increased with RADT implementation (25.4% vs. 9.7%: adjusted odds ratio 1.55; 95% CI, 1.50–1.60). At 63% of the facilities, the RADT implementation rate was <5% of acute pharyngitis visits prescribed antibiotics. In conclusion, the proportion of RADT usage for outpatients with acute pharyngitis was low in Japan. With appropriate indication and evaluation, we expect that more utilization of RADT can help promote antimicrobial stewardship for outpatients with acute pharyngitis by prompting penicillin therapy. Further investigation with detailed clinical data are warranted.

Original languageEnglish
JournalJournal of Infection and Chemotherapy
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

Pharyngitis
Observational Studies
Japan
Retrospective Studies
Anti-Bacterial Agents
Antigens
Penicillins
Outpatients
Statistical Factor Analysis
Prescriptions
Logistic Models
Physicians' Offices
Health Insurance
Streptococcus
Therapeutics
Odds Ratio

Keywords

  • Acute respiratory tract infection
  • Antibiotic prescription
  • Antimicrobial stewardship
  • Pharyngitis
  • Rapid antigen detection test

ASJC Scopus subject areas

  • Microbiology (medical)
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Association between rapid antigen detection tests and antibiotics for acute pharyngitis in Japan : A retrospective observational study. / Teratani, Yusuke; Hagiya, Hideharu; Koyama, Toshihiro; Ohshima, Ayako; Zamami, Yoshito; Tatebe, Yasuhisa; Tasaka, Ken; Shinomiya, Kazuaki; Kitamura, Yoshihisa; Sendo, Toshiaki; Hinotsu, Shiro; Kano, Mitsunobu R.

In: Journal of Infection and Chemotherapy, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "The application and clinical impact of rapid antigen detection test (RADT) in the treatment of acute pharyngitis is unknown in Japan. We aimed to examine the proportions of RADT usage to identify Group A β-hemolytic Streptococcus (GAS) in outpatients with acute pharyngitis and evaluate the association between RADT and antibiotic treatment. We analyzed health insurance claims data from 2013 to 2015. Logistic regression models were used to analyze associated factors with RADT, overall antibiotic prescription, or penicillin use. We analyzed 1.27 million outpatient visits with acute pharyngitis, in which antibiotics were prescribed in 59.3{\%} of visits. Of the total visits, 5.6{\%} of patients received RADT, and 10.8{\%} of the antibiotics were penicillin. Penicillin selection rates were higher in cases with RADT (25.4{\%}) than those without RADT (9.7{\%}). Compared to large-scale facilities, antibiotic prescription rates were higher in physicians’ offices. For factor analysis, age (3–15 years), diagnosis code (streptococcal pharyngitis), size of the medical facility (large-scale hospitals), and physician's specialty (pediatrics) were associated with RADT use. Penicillin selection rate increased with RADT implementation (25.4{\%} vs. 9.7{\%}: adjusted odds ratio 1.55; 95{\%} CI, 1.50–1.60). At 63{\%} of the facilities, the RADT implementation rate was <5{\%} of acute pharyngitis visits prescribed antibiotics. In conclusion, the proportion of RADT usage for outpatients with acute pharyngitis was low in Japan. With appropriate indication and evaluation, we expect that more utilization of RADT can help promote antimicrobial stewardship for outpatients with acute pharyngitis by prompting penicillin therapy. Further investigation with detailed clinical data are warranted.",
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AU - Teratani, Yusuke

AU - Hagiya, Hideharu

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AU - Ohshima, Ayako

AU - Zamami, Yoshito

AU - Tatebe, Yasuhisa

AU - Tasaka, Ken

AU - Shinomiya, Kazuaki

AU - Kitamura, Yoshihisa

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AU - Hinotsu, Shiro

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