{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T12:06:30Z","timestamp":1776773190340,"version":"3.51.2"},"reference-count":16,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2003,6,1]]},"abstract":"<jats:p>Objective. The American Academy of Pediatrics recommends that all negative rapid diagnostic tests for Streptococcus pyogenes pharyngitis be backed up by culture, which creates a dilemma for clinicians who must make treatment decisions without complete diagnostic information at the time of visit. The use of a follow-up serial rapid antigen test instead of a follow-up culture would provide a more timely result.<\/jats:p>\n               <jats:p>Methods. Two swabs were collected from children who were suspected of having S pyogenes pharyngitis. Each swab was used for a culture and an OSOM Ultra Strep A Test rapid antigen test. The gold standard of comparison was defined as the identification of S pyogenes on either of the 2 culture plates. Three diagnostic strategies were evaluated: a single rapid antigen test, a rapid antigen test with follow-up rapid antigen test (rapid-rapid), and a rapid antigen test with follow-up culture (rapid-culture).<\/jats:p>\n               <jats:p>Results. A total of 210 (23.7%) of 887 throat cultures with matched data were identified with S pyogenes. A single rapid antigen test had a sensitivity of 87.6% (95% confidence interval [CI]: 83.2%\u201392.1%), the sensitivity of the rapid-rapid follow-up was 91.4% (95% CI: 87.6%\u201395.2%), and the sensitivity of the rapid-culture follow-up was 95.7% (95% CI: 93.0%\u201398.5%), which was significantly higher than the others. As shown in Fig 1, when these test strategies were evaluated on a subgroup with clinical symptoms commonly associated with S pyogenes pharyngitis, the sensitivities all increased and were no longer significantly different. None of the strategies reliably exceeded a 95% sensitivity threshold.<\/jats:p>\n               <jats:p>Conclusions. The American Academy of Pediatrics strategy for S pyogenes detection in children with pharyngitis, requiring a backup culture for those with negative antigen tests, was not exceeded by any other test strategy; however, a rapid-rapid diagnostic strategy may approximate it with the use of judicious clinical selection of patients.<\/jats:p>","DOI":"10.1542\/peds.111.6.e666","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:43:47Z","timestamp":1092444227000},"page":"e666-e670","source":"Crossref","is-referenced-by-count":58,"title":["Evaluating the American Academy of Pediatrics Diagnostic Standard for <i>Streptococcus pyogenes<\/i> Pharyngitis: Backup Culture Versus Repeat Rapid Antigen Testing"],"prefix":"10.1542","volume":"111","author":[{"given":"Karen E.","family":"Gieseker","sequence":"first","affiliation":[{"name":"Departments of Epidemiology"},{"name":"Departments of Preventive Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martha H.","family":"Roe","sequence":"additional","affiliation":[{"name":"Pathology, Children\u2019s Hospital"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd","family":"MacKenzie","sequence":"additional","affiliation":[{"name":"Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James K.","family":"Todd","sequence":"additional","affiliation":[{"name":"Departments of Epidemiology"},{"name":"Pathology, Children\u2019s Hospital"},{"name":"Departments of Preventive Medicine"},{"name":"Microbiology"},{"name":"Pediatrics, University of Colorado Health Sciences Center, Denver, Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2003,6,1]]},"reference":[{"key":"2021120821111161200_R1","unstructured":"Schappert SM. Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 1997. Vital Health Stat 13.1999;(143):I\u2013iv, 1\u201339"},{"key":"2021120821111161200_R2","doi-asserted-by":"crossref","unstructured":"Wannamaker LW. Perplexity and precision in the diagnosis of streptococcal pharyngitis. Am J Dis Child.1972;124:352\u2013358","DOI":"10.1001\/archpedi.1972.02110150050009"},{"key":"2021120821111161200_R3","unstructured":"Dowell SF, Schwartz B, Phillips WR. Appropriate use of antibiotics for URIs in children: part II. Cough, pharyngitis and the common cold. The Pediatric URI Consensus Team. Am Fam Physician.1998;58:1335\u20131342"},{"key":"2021120821111161200_R4","unstructured":"American Academy of Pediatrics, Committee on Infectious Diseases. Group A streptococcal infections. In: The Red Book. 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