Latest news with #randomizedcontrolledtrials
Medscape
23-07-2025
- Health
- Medscape
Point-of-Care Testing Cuts Antibiotic Use in Pharyngitis
TOPLINE: Point-of-care testing for group A beta-hemolytic Streptococcus (Strep A) significantly reduced antibiotic prescriptions in children and adults with signs of pharyngitis, even when used as the sole intervention. METHODOLOGY: Researchers performed a meta-analysis of eight randomized controlled trials conducted between 2007 and 2021, evaluating point-of-care testing for Strep A vs standard care. The analysis included 4249 children and adults with pharyngitis, cough, or sore throat who underwent point-of-care testing for Strep A either alone or alongside other interventions. Primary outcomes were the impacts on antibiotic prescriptions, clinical decisions, and patient health outcomes. Secondary endpoints assessed diagnostic accuracy of Strep A testing, including sensitivity and specificity measurements. TAKEAWAY: Point-of-care testing reduced antibiotic prescriptions by 38% compared with standard care (risk ratio [RR], 0.62; P < .0001) and by 41% when it was the sole intervention (RR, 0.59; P < .001). The implementation of point-of-care testing also led to a reduction in inappropriate antibiotic prescriptions (RR, 0.45; 95% CI, 0.31-0.97; P = .038). However, there were no significant differences in the patient health outcomes, such as days until pain resolution and days of school/work missed, the use of ancillary testing, or other medications such as analgesics with point-of-care testing. The reported diagnostic accuracy of Strep A point-of-care testing showed sensitivity ranging from 65% to 94% and specificity from 85% to 94%. IN PRACTICE: 'Physicians can therefore use Strep A POCTs [point-of-care tests] to inform their decisions on antibiotic prescribing without compromising patient health outcomes. In clinical practice, physicians must be aware of the limitations of Strep A POCTs, in particular, the limited sensitivity for detecting GAS [group A beta-hemolytic Streptococcus],' the authors of the study wrote. SOURCE: This study was led by Ann-Sophie Mägdefrau and Carolin Kathner-Schaffert, Jena University Hospital and InfectoGnostics Research Campus Jena, both in Jena, Germany. It was published online on July 9, 2025, in Open Forum Infectious Diseases. LIMITATIONS: High statistical heterogeneity in the meta-analyses limited the precision of the pooled effect estimates. Only three trials reported patient health outcomes, restricting evaluation of the effect of Strep A point-of-care tests on measures like recovery time. Additionally, none of the trials were blinded, introducing potential bias — particularly in evaluating subjective outcomes like pain and symptom resolution. DISCLOSURES: This study received funding from the German Federal Ministry of Education and Research. The authors reported having no relevant conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
09-06-2025
- Health
- Medscape
Antenatal Corticosteroids Safe for Child Development
A systematic review of 14 studies found that most neurodevelopmental outcomes showed no association with antenatal corticosteroids. While modest decreases were noted in nonverbal intelligence and visual memory scores, studies with a strong design showed no link to adverse development. METHODOLOGY: Researchers conducted a systematic review and meta-analysis of 14 studies, comprising eight randomized controlled trial follow-up studies (n = 2233) and six quasi-experimental studies (n = 277,679). Analysis utilized random-effects meta-analyses to synthesize outcomes based on blinded adjudication of appropriateness for pooling by clinical experts in child neurodevelopment. Investigators evaluated the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation methodology. A total of 23 neurodevelopmental outcomes were examined. TAKEAWAY: Most neurodevelopmental outcomes (19/23) showed no association with antenatal corticosteroid administration. Children exposed to antenatal corticosteroids showed modestly decreased nonverbal intelligence scores (standardized mean difference [SMD], -0.16; 95% CI, -0.32 to -0.01) and visual memory scores (SMD, -0.29; 95% CI, -0.51 to -0.07). Randomized trial follow-ups indicated a nonsignificant trend toward protective effects for general development, while quasi-experimental studies suggested increased risk. Studies with low or moderate risk for bias revealed no association between antenatal corticosteroid administration and adverse child neurodevelopment. IN PRACTICE: 'Among studies with low or moderate risk of bias, we found no association between antenatal corticosteroid administration and adverse child neurodevelopment. There is no consistent evidence that antenatal corticosteroids are associated with an increased risk of impaired childhood neurodevelopment among studies with a strong design to control for confounding,' wrote the authors of the study. SOURCE: The study was led by Jessica Liauw, MD, Department of Obstetrics and Gynaecology at University of British Columbia in Vancouver, Canada. It was published online in Obstetrics & Gynecology . LIMITATIONS: Most randomized controlled trial follow-up studies had significant losses to follow-up, with the two largest studies experiencing 66% and 40% attrition rates, leading to potential selection bias. Researchers noted that few studies specifically investigated the effects of antenatal corticosteroids administered in the late preterm period, limiting understanding of the timing-specific impacts. Additionally, the authors acknowledged that sibling-comparison studies did not adequately control for differences in pregnancy complications that determine why corticosteroids were administered in one pregnancy but not another. DISCLOSURES: The study was supported by a project grant from the Canadian Institutes of Health Research. Liauw received a Michael Smith BC Health Professional Investigator Award, and Jennifer Hutcheon, PhD, was supported by a Canada Research Chair in perinatal population health. The funders had no role in the research design or manuscript submission decisions. The authors reported no potential conflicts of interest.
