I am not sure of the value of the previous cost-benefit analysis by Dr.
If we assume that all ARF is caused by GABHS and that the bacteria is
100% sensitive to antibiotics, then the population attributable risk of "not
treating with ABX" is 100%.
Since the sensitivity and specifity of combined Rapid strep and culture
is quite high, and the prevalence of the disease among the select
population (children greater than 5 with sorethroats) is also high, then the
positive predictive value should be high. Very few cases will be missed and
less needless abx will be prescribed which is of clear benefit to the public.
My understanding is that the 1-2 day delay in treatment while waiting for
the culture does not increase the risk of ARF.
I can think of no argument to justify treating everyone, unless your
department refuses to do rapid streps and cannot do follow-up on patients
for socioeconmic reasions.
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