Why Point-of-Care Strep Testing Is Critical for Antibiotic Stewardship

The Importance of Proper Diagnosis for Strep A Infections

Group A streptococcal pharyngitis, more commonly known as Strep Throat, is a bacterial infection of the throat (pharyngeal) tissues. It’s caused by Group A strep bacteria, Streptococcus pyogenes, and the illness can be caused by three different strains of this bacteria: Strep C, Strep G, or Strep A. Only one of these strains requires an antibiotic for treatment, while the other two can be fought off by a healthy immune system and the support of the proper treatment plan. Why is all this important? Because an untreated Strep A infection, the strain which cannot be beat without an antibiotic, can result in an autoimmune response known as Rheumatic Fever or in kidney disease (1). The efforts of the body to defeat the Strep A infection without the aid of antibiotics can weaken or damage the heart muscle or the kidneys, amongst other potential complications. Adversely, treating Strep Throat that’s caused by Strep C or Strep G with an antibiotic unnecessarily exposes the body to antibiotics. Taking antibiotics when you don’t need them is needless exposure that can increase potential for an individual’s antibiotic resistance, meaning that those same antibiotics may not work effectively when needed to treat a future infection or illness (2). Even more reason why a patient should seek proper diagnosis and treatment for suspected Strep Throat infections, and a clinician needs a reliable testing protocol for accurately diagnosing and treating Strep Throat infections.

The Threat of Antibiotic Resistance and Strep A

In 2024, the CDC published the results of their 2019 Antibiotic Resistance Threat Report which included Erythromycin-Resistant Group A Streptococcus, filed under their Concerning Threat category (3). This is very concerning as Erythromycin, which is in the same class as Azithromycin (Zithromax), is a commonly used treatment for strep throat infections (4). Why does this matter for clinicians and patients? What contributes to a microbe or patient developing resistance to antibiotics? In short, misuse or overuse of antibiotics (a.k.a. antimicrobials) is the main driver of this growing concern (5). Patients who have been needlessly exposed to antibiotics may develop resistance. Organisms, like bacteria, which are overexposed to antibiotics may develop resistance.

Now you may be thinking this all sounds scary but you’re unsure how this might impact you. Imagine that you’re a parent with a sick child. You take your little one to the doctor’s office, where they are diagnosed with strep throat and given a prescription for an antibiotic. You pick up the script at the pharmacy, take your child home, make them comfortable and give them their first dose of antibiotics. Several days go by and their symptoms have not improved. They are feeling miserable. You take them back to the doctor who runs more tests. It’s discovered that the bacterial strain causing their strep throat infection is resistant to the antibiotic their doctor prescribed. A new antibiotic prescription is given but the extended exposure to the strep infection has taxed their little body. The doctor is now concerned about the potential for rheumatic fever, which could cause damage to your child’s heart muscle. You now have additional concerns about their health because the all-too-common strep throat infection they contracted is resistant to the most common treatment. It’s a scary situation for you, as a parent, and one that no doctor wants to see their patient have to face. Imagine if your child was the one who was resistant to the antibiotic. What if they had been unnecessarily prescribed common antibiotics so frequently that their body had developed a resistance to them. Now common illnesses would need to be treated differently, possibly with stronger antibiotics that carry harsher side effects. Is this where we are today? No. Could this be where we end up in the future without the vigilance of care providers and patients concerning the proper use of antibiotics? Potentially.

The Need for Quality Diagnostics at the Point-of-Care

What can be done at the point of care to reduce these risks? According to the CDC’s Clinical Guidance on strep throat infections, ensuring proper antibiotic usage for strep throat infections starts with testing and diagnosis. It’s recommended that healthcare providers utilize a rapid antigen detection test (RADT) and throat culture to determine the presence of a Strep A infection, and prior to prescribing antibiotics (6). Clinicians can work with manufacturer and/or distribution reps to assess the diagnostic solution that fits best for their clinical practice. Patients can hold their care providers accountable by asking about their diagnostic methods for strep infections and being open to leaving an office visit without an antibiotic if it’s deemed unnecessary for their treatment. Ensuring proper diagnostics are utilized at the point of care can be a great step in the right direction for antibiotic stewardship.

Click here to learn more about SEKISUI Diagnostics' OSOM® Strep A Test.

References

1. Valencia, Anna Maria. Omega Pediatrics. [Online] August 17, 2024. https://www.omegapediatrics.com/consequences-of-untreated-strep-throat/.
2. UNC Healthcare. UNC Health Talk. What Happens If You Take An Antibiotic You Don't Need? [Online] UNC Healthcare, February 22, 2024. https://healthtalk.unchealthcare.org/what-happens-if-you-take-an-antibiotic-you-dont-need/#:~:text=Taking%20antibiotics%20unnecessarily%20can%20cause%20you%20to%20build,chances%20to%20learn%20how%20to%20outsmart%20the%20medication..
3. CDC. 2019 Antibiotic Resistance Threats Report. [Online] July 2024. https://www.cdc.gov/antimicrobial-resistance/data-research/threats/index.html.
4. Omudhome Ogbru, PharmD, Jay W, Marks MD. MedicineNet. Erythromycin. [Online] https://www.medicinenet.com/erythromycin/article.htm.
5. World Health Organization. Worth Health Organization. Antimicrobial Resistance. [Online] November 2023. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance.
6. Center for Disease Control. CDC. Clinical Guidance for Group A Streptococcal Pharyngitis. [Online] March 2024. https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/strep-throat.html.