Clinical Trials Logo

Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT01720927
Other study ID # PK-12-02
Secondary ID
Status Completed
Phase N/A
First received November 1, 2012
Last updated September 12, 2014
Start date November 2012
Est. completion date November 2013

Study information

Verified date September 2014
Source Hill Park General Hospital
Contact n/a
Is FDA regulated No
Health authority Pakistan: Research Ethics Committee
Study type Observational

Clinical Trial Summary

GABHS are common etiological agents for acute pharyngitis. However, local data is limited and large scale surveillance studies have not been done. This study aims to evaluate the disease burden in the community due to GABHS.

In this study, patients presenting with signs of acute pharyngitis will be evaluated. Patients with fulfilling the inclusion criteria will be tested for Rapid Antigen Detection test (RADT)


Description:

Pharyngitis is a common reason for patients' visit to doctors. Group A beta- hemolytic streptococci (GABHS) account for 15-30 percent of cases of acute pharyngitis in children and 5 to 20 percent in adults1.

Because the signs and symptoms of GABHS pharyngitis overlap extensively with other infectious causes, making a diagnosis based solely on clinical findings is difficult. In patients with acute febrile respiratory illness, physicians accurately differentiate bacterial from viral infections using only the history and physical findings about one half of the time.2 No single element of the patient's history or physical examination reliably confirms or excludes GABHS pharyngitis.3 Sore throat, fever with sudden onset (temperature greater than 100.4° F [38° C]), and exposure to Streptococcus within the preceding two weeks suggest GABHS infection. Cervical node lymphadenopathy and pharyngeal or tonsillar inflammation or exudates are common signs. Palatal petechiae and scarlatiniform rash are highly specific but uncommon; a swollen uvula is sometimes noted. Cough, coryza, conjunctivitis, and diarrhea are more common with viral pharyngitis.

The original Centor score uses four signs and symptoms to estimate the probability of acute streptococcal pharyngitis in adults with a sore throat.4 The score was later modified by adding age and validated in 600 adults and children.5,6 The cumulative score determines the likelihood of streptococcal pharyngitis.

Rapid Antigen Detection Tests (RADTs) have been developed for the identification of GABHS directly from throat swabs. Although these rapid tests are more expensive than blood agar culture, they provide results faster. Rapid identification and treatment of patients with streptococcal pharyngitis can reduce the risk of the spread of group A b-hemolytic streptococci, allowing the patient to return to school or work sooner, and can reduce the acute morbidity associated with the illness. The use of RADTs for certain populations (e.g., patients in emergency departments) has been shown to significantly increase the number of patients who are appropriately treated for streptococcal pharyngitis, compared with use of traditional throat cultures.7

The great majority of the RADTs that are currently available have an excellent specificity of 95%, compared with blood agar plate culture. This means that false-positive test results are unusual, and, therefore, therapeutic decisions can be made with confidence on the basis of a positive test result. Unfortunately, the sensitivity of most of these tests is 80%-90%, or even lower, compared with blood agar plate culture. It has been suggested that most of the false-negative RADT results occur for patients who are merely Streptococcus carriers and are not truly infected. However, early studies of first-generation RADTs demonstrated that a large proportion of patients with false-negative RADT results were truly infected with group A b-hemolytic streptococci and were not merely carriers.8

Acute pharyngitis is commonly encountered in clinics and hospitals across Pakistan. It is common not only in children but also among adults. Limited data are available on the prevalence of this condition and existing data are from small single center based studies.

The available data from Pakistan suggest that the most common bacterial organism is GABHS, however, majority of throat swabs did not yield any isolate.9 The signs and symptoms of GABHS pharyngitis overlap extensively with other infectious causes, thus to make an etiologic diagnosis based solely on clinical findings is difficult. Improving diagnosis of bacterial causes of pharyngitis will lead to more rational use of antibiotics among clinicians, and potentially have a positive impact on the development of bacterial resistance in community acquired infections.

The modified Centor score is a valid tool to estimate the probability of acute streptococcal pharyngitis in patients with a sore throat. (reference) Patients with a score of zero or 1 are at very low risk for streptococcal pharyngitis and do not require testing (i.e., throat culture or rapid antigen detection testing [RADT]) or antibiotic therapy. Patients with a score of 2 or 3 should be tested using RADT or throat culture; positive results warrant antibiotic therapy. Patients with a score of 4 or higher are at high risk of streptococcal pharyngitis, and empiric treatment may be considered. (reference)

RADT allows for earlier treatment, symptom improvement, and reduced disease spread.


Recruitment information / eligibility

Status Completed
Enrollment 5140
Est. completion date November 2013
Est. primary completion date November 2013
Accepts healthy volunteers No
Gender Both
Age group 3 Years and older
Eligibility Inclusion Criteria:

- Male and female subjects with signs of acute pharyngitis (duration of symptoms < 14 days)

- Subjects with sore throat

- Fever with sudden onset (temperature > 100 0 F (380 C)

- Exposure to Streptococcus within the preceding 2 weeks

- Children 3 years of age and above

- Subjects / guardians giving written authorization to participate in the study

Exclusion Criteria:

- Recurrent or persistent cases of sore throat

- Complicated pharyngitis (peritonsillar abscesses, Lemierre disease, Vincent's angina)

- Severe comorbidity

- Immunosuppression or history of acute rheumatic fever

- Special circumstances, such as sore throat after travel in past 2 weeks, sore throat linked to sexual transmission or rare epidemics (e.g. diphtheria)

Study Design

Observational Model: Case-Only, Time Perspective: Prospective


Related Conditions & MeSH terms


Locations

Country Name City State
Pakistan ISRA University Hyderabad Sind

Sponsors (2)

Lead Sponsor Collaborator
Suresh Kumar ISRA University

Country where clinical trial is conducted

Pakistan, 

Outcome

Type Measure Description Time frame Safety issue
Primary To evaluate the prevalence of GABHS in patients with acute pharyngitis. 12 months No
Secondary To study the prevalence of GABHS in acute pharyngitis across different age groups. 12 months No
Secondary To study the correlation of centor score and RADT results. 12 months No
See also
  Status Clinical Trial Phase
Completed NCT01986361 - Placebo-Controlled Onset-of-Action Study of Flurbiprofen Utilizing the Double-Stopwatch Method Phase 3
Completed NCT04027322 - Inhaled Steroids for Acute Pharyngitis. Phase 2/Phase 3
Completed NCT04203810 - Effectiveness and Tolerability of Ectoin® Mouth and Throat Spray Althaea Honey (ERS09) N/A
Completed NCT02160912 - Non Interventional Study (NIS) Regarding the Application of Ectoin Mund- & Rachenspray in Patients With Acute Laryngitis and/or Acute Pharyngitis N/A
Terminated NCT04470089 - A Clinical Trial Investigating the Short-term Relief of Symptoms of Acute Pharyngitis by Treatment With Three Different Doses of MYRAMISTIN™ Oromucosal Spray Phase 2