Febrile 70: Strep on the GAS!
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Apr 3, 2023 Anastasia “Tash” Theodosiou, a PhD candidate and registrar in infectious diseases, joins Chrissie Jones, an associate professor of pediatric infectious diseases, to tackle the surge in Group A Streptococcus cases in the UK. They delve into differentiating viral from bacterial pharyngitis, effective swabbing practices, and antibiotic treatment strategies. They also address alternative antibiotics, the implications of macrolide resistance, and why clindamycin is crucial in severe cases. Lastly, they explore the global burden of GAS and ongoing efforts for a vaccine.
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How To Assess Sore Throat Risk
- Most pediatric sore throats are viral, but up to 30% in children can be group A strep, peaking around age 7–8.
- UK uses FeverPAIN for treatment decisions while the US often uses Centor to decide on swabbing.
Use Rapid Tests With Pretest Probability
- Use rapid antigen tests cautiously because sensitivity can be ~70% and depends on pretest probability.
- Treat positive rapid tests as definitive but confirm negatives with culture if pretest probability is high.
Treat To Protect Vulnerable Contacts
- Treat children scoring high on FeverPAIN/Centor to reduce symptoms briefly and prevent transmission to vulnerable contacts.
- The number needed to treat to prevent one pneumonia in elderly contacts is ~39, supporting treatment to protect others.