Evaluating an Antibiotic Stewardship for Sore Throat in Primary Care

Key Takeaways

• A 6-month antimicrobial stewardship program for acute sore throat combined guideline-reflection meetings, didactic case discussions, local quality improvement work, and repeated audit and feedback using laboratory and prescribing data.
• Long-term follow-up did not show improved guideline adherence in intervention centres compared with control centres.
• The primary outcome was the change in the proportion of antibiotic-prescribed cases with a positive rapid antigen detection test for Streptococcus pyogenes, and the authors concluded long-term guideline adherence was not improved.

A randomized trial in Swedish primary care found no significant long-term improvement in guideline adherence after a 6-month multifaceted antimicrobial stewardship program for acute sore throat.

Researchers conducted a randomized controlled trial in primary care centrers in Sweden, with centers assigned to either the intervention group or the control group. The clinical focus was acute sore throat, including pharyngotonsillitis managed in routine primary care practice.

Over 6 months, the program combined guideline-reflection meetings, didactic patient case discussions, local quality improvement initiatives, and repeated individual audit and feedback. These audit and feedback cycles used laboratory and prescribing data to test whether structured stewardship could change guideline adherence over time.

The primary outcome was the change in the proportion of antibiotic-prescribed cases with a positive rapid antigen detection test for Streptococcus pyogenes. The measure served as the trial’s indicator of adherence to the Swedish national sore throat guideline. Investigators found no significant change in guideline adherence from baseline at 6, 12, or 18 months in either group. The follow-up pattern indicated stable adherence rather than measurable movement after the intervention period across the assessed time points.

At study entry, approximately two-thirds of pharyngotonsillitis cases were managed in accordance with the Swedish national guideline. The trial was set against concern that sore throat guideline adherence remains limited in primary care despite national guidance.

The authors concluded that the 6-month multifaceted antimicrobial stewardship program did not improve long-term guideline adherence for these patients.