چکیده (انگلیسی):

Background:Excessive antibiotics use increases the risk of resistance. Previous studies have shown that the Centor
score combined with Rapid Antigen Detection Test (RADT) for Group A Streptococci can reduce unnecessary
antibiotic prescribing in patients with sore throat. According to the former Swedish guidelines RADT was recommended
with 2–4 Centor criteria present and antibiotics were recommended if the test was positive. C- reactive protein (CRP)
was not recommended for sore throats. Inappropriate use of RADT and CRP has been reported in several studies.
Methods:From a larger project 16 general practitioners (GPs) who stated management of sore throats not according
to the guidelines were identified. Half-hour long semi-structured interviews were conducted. The topics were the
management of sore throats and the use of near-patient tests. Qualitative content analysis was used.
Results:The use of the near-patient test interplayed with the clinical assessment and the perception that all
infections caused by bacteria should be treated with antibiotics. The GPs expressed a belief that the clinical
picture was sufficient for diagnosis in typical cases. RADT was not believedto be relevant since it detects only
one bacterium, while CRP was considered as a reliable numerical measure of bacterial infection.
Conclusions:Inappropriate use of near-patient test can partly be understood as remnants of outdated knowledge.
When new guidelines are introduced the differences between them and the former need to be discussed more explicitly.
Keywords:Near-patient tests, Sore throat, Guidelines, Decision-making, Qualitative interview studyBackground:Excessive antibiotics use increases the risk of resistance. Previous studies have shown that the Centor
score combined with Rapid Antigen Detection Test (RADT) for Group A Streptococci can reduce unnecessary
antibiotic prescribing in patients with sore throat. According to the former Swedish guidelines RADT was recommended
with 2–4 Centor criteria present and antibiotics were recommended if the test was positive. C- reactive protein (CRP)
was not recommended for sore throats. Inappropriate use of RADT and CRP has been reported in several studies.
Methods:From a larger project 16 general practitioners (GPs) who stated management of sore throats not according
to the guidelines were identified. Half-hour long semi-structured interviews were conducted. The topics were the
management of sore throats and the use of near-patient tests. Qualitative content analysis was used.
Results:The use of the near-patient test interplayed with the clinical assessment and the perception that all
infections caused by bacteria should be treated with antibiotics. The GPs expressed a belief that the clinical
picture was sufficient for diagnosis in typical cases. RADT was not believedto be relevant since it detects only
one bacterium, while CRP was considered as a reliable numerical measure of bacterial infection.
Conclusions:Inappropriate use of near-patient test can partly be understood as remnants of outdated knowledge.
When new guidelines are introduced the differences between them and the former need to be discussed more explicitly.