Samenvatting
De kern
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In Nederland worden antibiotica overmatig vaak voorgeschreven ter behandeling van acute keelpijn.
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De NHG-Standaard adviseert het beleid te laten afhangen van het klinische beeld en raadt het gebruik van de streptest niet aan.
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De streptest heeft een hoge diagnostische waarde, ook in de huisartsenpraktijk.
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Vooral bij patiënten met veel klinische verschijnselen zou de streptest kunnen leiden tot matiging van het antibioticagebruik.
Achtergrond
Methode
Resultaten
Onderzoek | Prevalentie GABHS | Setting | n | Leeftijd | Inclusie | Exclusie | Referentietest | Streptest | PVW | NVW |
---|---|---|---|---|---|---|---|---|---|---|
Rimoin 2010 | Brazilië: 24,5%Kroatië: 39,4%Egypte: 26,4%Letland: 29,5% | pediatrische poliklinieken | 2472 | 2-12 jr | acute keelpijn | AB in afgelopen 3 dagen | BAP, 48u | Strep A OIA MAX | 67,9-88,6% | 88,1-95,7% |
Llor 2009 | Spanje: 24,8% | zorgcentrum | 222 | > 14 jr | acute keelpijn met 2 of meer centorcriteria | AB in afgelopen 2 weken | BAP, 48u | OSOM Strep A | 78,8% | 98,1% |
Humair 2006 | Zwitserland: 37,6% | zorgcentrum | 372 | >15 jr | acute keelpijn met 2 of meer centorcriteria | 2 kweken, BAP, 48u | TestPack Plus Strep A | 92,1% | 94,9% | |
Lindbaek 2004 | Noorwegen: 42% | 2 huisartsenpraktijken | 306 | alle | keelpijn < 7 dagen | AB in afgelopen 2 weken | 2 kweken BAP, 48u | TestPack Plus Strep A | 92% | 98% |
Nerbrand 2002 | Zweden: 15,3% | 8 zorgcentra | 615 | alle | klinische diagnose van acute keelpijn | eerder AB | BAP, 24u | TestPack plus Strep A | 87,8% | 94,2% |
Dagnelie 1998 | Nederland: 33% | 53 huisartsenpraktijken | 558 | 4-60 jr | acute keelpijn < 15 dagen | – | BAP, 48u | Directigen 1-2-3 Group A Strep Test | 88% | 85% |
Discussie
Literatuur
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