Most people assume a 90% effectiveness of oral treatment for GABHS because of
Most reasonable clinicians would come down where you do, i.e. treat only those
with a high likelihood of disease based on testing. But based on the
aforementioned cost anlaysis by Webb (Peds Electronic Pages, Feb 98) the most
cost effective strategy is to treat all comers with pharyngitis without ANY
testing. It's only when you take into account the patients getting allergic
reactions to penicillin, most of whom did not have Strep. after all, and the
undesirable long-term effects (not costed out in the anlaysis, BTW) of
possible drug resistance in the future that testing becomes favorable.
I favor the rapid Strep. test, with treatment if positive, based on the above.
I agree with original post re decision analysis being important (though his
70% effectiveness was flawed), because it allows us to identify explicitly the
factors important to the decision (and allows us to vary them and test the
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