000K utf8 1100 $c2023 1500 eng 2050 urn:nbn:de:gbv:8:3-2025-01139-4 2051 10.1186/s12875-023-01987-w 3000 Wächtler, Hannelore 3010 Donner-Banzhoff, Norbert 3010 Hansmann-Wiest, Julia 3010 Hedderich, Jürgen 3010 Kaduszkiewicz, Hanna 3010 Kuhnert, Oskar 3010 Maaß, Sonja 3010 Malottki, Karolina Agata 3010 Wiese, Birgitt 4000 Influence of a guideline or an additional rapid strep test on antibiotic prescriptions for sore throat: the cluster randomized controlled trial of HALS (Hals und Antibiotika Leitlinien Strategien)$hSpringer Science and Business Media LLC [Wächtler, Hannelore] 4030 $nSpringer Science and Business Media LLC 4209 HALS was an open pragmatic parallel group three-arm cluster-randomized controlled trial. Primary care practices in Northern Germany were randomized into three groups: Guideline (GL-group), modified guideline with a RADT for scores ≥ 3 (GL-RADT-group) or usual care (UC-group). All practices were visited and instructed by the study team (outreach visits) and supplied with material according to their group. The practices were asked to recruit 11 consecutive patients ≥ 2 years with an acute sore throat and being at least moderately impaired. A study throat swab for GAS was taken in every patient. The antibiotic prescription rate at the first consultation was the primary outcome. Results From October 2010 to March 2012, 68 general practitioners in 61 practices recruited 520 patients, 516 could be analyzed for the primary endpoint. Antibiotic prescription rates did not differ between groups (p = 0.162) and were about three times higher than the GAS rate: GL-group 97/187 patients (52%; GAS = 16%), GL-RADT-group 74/172 (43%; GAS = 16%) and UC-group 68/157 (43%; GAS = 14%). In the GL-RADT-group 55% of patients had scores ≥ 3 compared to 35% in GL-group (p < 0.001). After adjustment, in the GL-RADT-group the OR was 0.23 for getting an antibiotic compared to the GL-group (p = 0.010), even though 35 of 90 patients with a negative Strep-test got an antibiotic in the GL-RADT-group. The prescription rates per practice covered the full range from 0 to 100% in all groups. Conclusion The scores proposed in the implemented guideline seem inappropriate to lower antibiotic prescriptions for sore throat, but better adherence of practitioners to negative RADTs should lead to fewer prescriptions. Trial registration DRKS00013018, retrospectively registered 28.11.2017. 4950 https://doi.org/10.1186/s12875-023-01987-w$xR$3Volltext$534 4950 https://nbn-resolving.org/urn:nbn:de:gbv:8:3-2025-01139-4$xR$3Volltext$534 4961 https://macau.uni-kiel.de/receive/macau_mods_00006680 5051 610 5550 Anti-Bacterial Agents 5550 Antibiotics 5550 Drug Prescriptions 5550 Group A Beta-Hemolytic Streptococci 5550 Guideline 5550 Humans 5550 Pain 5550 Pharyngitis 5550 Pharyngitis 5550 Point-of-care Test 5550 Primary Care 5550 Rapid Antigen Detection Test 5550 Rapid Strep Test 5550 Sore Throat 5550 Streptococcal Infections 5550 Streptococcus pyogenes