Abstract
BACKGROUND: Point-of-care testing (POCT) for group A β-hemolytic Streptococcus (StrepA) allows for rapid testing for streptococcal infection in patients with signs of pharyngitis. We conducted a systematic review and meta-analysis of the impact of StrepA POCTs on antibiotic prescribing and health outcomes in patients with signs of pharyngitis in outpatient care. METHODS: Medline, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs; January 2000-January 2025). Random-effects models were used to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs) for summary effect sizes. RESULTS: From 15 097 unique records, we identified 8 eligible RCTs comparing the use of StrepA POCTs with standard care. The use of StrepA POCTs reduced the number of antibiotics prescribed by 38% (RR, 0.62 [95% CI, .51-.77]; P < .001). In studies with StrepA POCTs as the sole intervention, antibiotic prescribing was reduced by 41% (RR, 0.59 [95% CI, .44-.78]; P < .001; 5 RCTs). The reduction in antibiotic prescribing was observed in children (RR, 0.56 [95% CI, .39-.81]; P = .002; 4 RCTs) and adults (RR, 0.57 [95% CI, .39-.85]; P = .006; 2 RCTs). The number of follow-up healthcare visits did not differ between StrepA POCT and standard care (RR, 0.56 [95% CI, .29-1.09]; P = .086, 3 RCTs). There were no differences between point estimates of individual RCTs for other patient health outcomes, such as days until pain resolution and days of school/work missed. CONCLUSIONS: The use of StrepA POCTs in children and adults with signs of pharyngitis likely reduces the number of antibiotics prescribed without compromising patient health outcomes.