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Diagnostic Stewardship

Inappropriate testing leads to Unncessary Antibiotics

Outpatient

Group A Streptococcus Testing

Licensed Professional Initiated Protocol: Obtaining Throat Swab for Group A Streptococcal Pharyngitis

Patient with sore throat, abdominal pain/nausea, headache, fever, tender cervical lymphadenopathy and/or scarlatiniform rash*

Prominent symptoms cough, runny nose, red eyes, hoarsness?

NO

Sores in mouth (>3 loose stools in a 24 hour period)?

NO

Under age 3 and no sick contacts with strep throat?

NO

Swab both tonsils and posterior pharynx*

Prominent symptoms cough, runny nose, red eyes, hoarsness?

YES

Do not swab throat*

NO
Sores in mouth (>3 loose stools in a 24 hour period)?
YES

Do not swab throat*

NO
Under age 3 and no sick contacts with strep throat?
YES

Do not swab throat*

NO

Swab both tonsils and posterior pharynx*

YES

YES

YES

Do not swab throat

*Diffuse erythema that blanches with pressure, with a “sandpaper” quality to the skin. It usually starts in the groin and armpits and is accompanied by circumoral pallor and a strawberry tongue. The rash is most marked in the skin folds of the inguinal axillary, antecubital, and abdominal areas and about pressure points.