Pediatric tonsilitis: modern tactics against an old foe

Abstract Background Pediatric tonsillitis (PT) impacts public health due to its widespread incidence and the prevalent overprescription of antibiotics driven by concerns over Group A β-hemolytic streptococcus (SGA) complications. Rapid antigen diagnostic tests (RADT) serve as vital tools for promptly identifying SGA infections in PT cases. However, despite their widespread availability, healthcare professionals often underutilize RADT, leading to inappropriate antibiotic prescriptions. Clinical audits and feedback to professionals emerge as solutions to this issue. Methods An audit was conducted on clinical cases of PT during 2023 to evaluate the correct usage of RADT and subsequent antibiotic prescription across various primary care practices in Lisbon, Portugal. Afterwards, a pilot practice was selected to assess the feasibility and utility of an online tool designed specifically to report RADT results and create a real-time surveillance system of incidence of SGA with feedback to prescribing clinicians. Following the revision of the reporting tool after the pilot, its implementation was extended to multiple practices across the Lisbon region. Results From the 1050 clinical cases analyzed, 992 had an indication to do a RADT according to the Portuguese guidelines, however only 282 (28.4%) tests were done. Overall, only 19.6% of PT cases were considered fully compliant. During the pilot, the introduction of the online tool led to a 3.259 increase in reporting (from 0.574 RADT/day to 1.872 RADT/day) for the same time period between February and March. Conclusions The implementation of an online reporting tool represents a significant advancement in SGA surveillance efforts, detecting cases promptly for public health interventions. This initiative underscores the importance of continuous quality improvement in diagnostics and shows digital tools’ potential for better disease surveillance in clinical settings. Key messages • Underutilization of RADT in PT cases contributes to inappropriate antibiotic prescriptions, compromising patient care. • Introduction of an online reporting tool significantly enhances RADT usage, aiding prompt SGA detection for improved public health interventions.