Pediatrician’s approach to diagnosis and management of group A streptococcal pharyngitis

Muzio, Ilenia Di; d’Angelo, Debora Mariarita; Battista, Caterina Di; Lapergola, Giuseppe; Zenobi, Ilaria; Marzetti, Valentina; Breda, Luciana; Altobelli, Emma

doi:10.1007/s10096-020-03821-y

Cited by 10 publications

(28 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Prevention and control measures/strategies Early/improved diagnosis and treatment [15,19,69,[79][80][81][82][83][84][85][86][87] Infection control in hospitals/aged care settings [31,32,39,42,[88][89][90][91][92][93] Epidemiological investigations/improved surveillance systems [94][95][96][97][98][99] Improved quality of housing [15,20] Health education for healthcare providers and patients/community [15,45,85,[100][101][102][103][104] Screening of healthcare workers, asymptomatic cases and post-exposure prophylaxis for vulnerable groups [32] Hand hygiene [15,42] Avoid overcrowding [15] Reduced malnutrition and HIV infection [17] Improved GAS detection methods [105,106] Capacity building of healthcare workers [29] Suggested future preventio...…”

Section: Key Findings or Conclusion Risk Or Strategy Referencesmentioning

confidence: 99%

“…The need for improved surveillance and epidemiological investigation was also emphasized by several articles [111][112][113][114][115][116]. This would be supported by improved detection methods [105,106] and health education at the hospital and community levels, including the capacity building of healthcare workers and education on the proper diagnosis and management of GAS diseases [15,29,45,85,[100][101][102][103][104].…”

Section: Prevention and Control Strategiesmentioning

confidence: 99%

“…For example, a study carried out in Italy in 2017-2018 on pediatricians' knowledge of the diagnosis and management of GAS infections showed that only 8% of 154 pediatricians correctly answered all of the questions on GAS diagnosis and management. Understanding diagnosis and management is particularly important in reducing the incidence of GAS sequelae [101].…”

Section: Risk Factors For Gas Infectionsmentioning

confidence: 99%

“…The support of antisepsis measures during delivery and neonatal cord care was also identified as important to the prevention strategy to reduce GAS transmission among birthing women and neonates [17]. Medical practitioners are also required to adhere to the diagnosis and treatment guidelines to effectively control GAS infections [35,101,124]. This review also advocates for the proper management of co-infections, such as influenza [78], and patients who have undergone surgical interventions, such as tonsillectomy and other similar operations [40,142], so as to reduce the risk of the development of GAS infections.…”

Section: Prevention and Control Measures/strategiesmentioning

confidence: 99%

“…Health education for healthcare providers, patients and communities is key for the prevention of GAS infections [15,45,85,[100][101][102][103][104]. This should include messages that encourage people to cover coughs or sneezes with a tissue or a forearm, which is effective in the prevention of most infections transmitted through respiratory droplets [49,143].…”

Section: Prevention and Control Measures/strategiesmentioning

confidence: 99%

See 4 more Smart Citations

A Review of Streptococcus pyogenes: Public Health Risk Factors, Prevention and Control

2021

View full text Add to dashboard Cite

Streptococcus pyogenes, (colloquially named “group A streptococcus” (GAS)), is a pathogen of public health significance, infecting 18.1 million people worldwide and resulting in 500,000 deaths each year. This review identified published articles on the risk factors and public health prevention and control strategies for mitigating GAS diseases. The pathogen causing GAS diseases is commonly transmitted via respiratory droplets, touching skin sores caused by GAS or through contact with contaminated material or equipment. Foodborne transmission is also possible, although there is need for further research to quantify this route of infection. It was found that GAS diseases are highly prevalent in developing countries, and among indigenous populations and low socioeconomic areas in developed countries. Children, the immunocompromised and the elderly are at the greatest risk of S. pyogenes infections and the associated sequelae, with transmission rates being higher in schools, kindergartens, hospitals and residential care homes. This was attributed to overcrowding and the higher level of social contact in these settings. Prevention and control measures should target the improvement of living conditions, and personal and hand hygiene. Adherence to infection prevention and control practices should be emphasized in high-risk settings. Resource distribution by governments, especially in developed countries, should also be considered.

show abstract

Section: Key Findings or Conclusion Risk Or Strategy Referencesmentioning

confidence: 99%

Section: Prevention and Control Strategiesmentioning

confidence: 99%

Section: Risk Factors For Gas Infectionsmentioning

confidence: 99%

Section: Prevention and Control Measures/strategiesmentioning

confidence: 99%

Section: Prevention and Control Measures/strategiesmentioning

confidence: 99%

See 3 more Smart Citations

A Review of Streptococcus pyogenes: Public Health Risk Factors, Prevention and Control

2021

View full text Add to dashboard Cite

show abstract

Acute pharyngitis in children and adults: descriptive comparison of current recommendations from national and international guidelines and future perspectives

Pellegrino,

Timitilli,

Verga

et al. 2023

Eur J Pediatr

View full text Add to dashboard Cite

This study aims to provide a comparison of the current recommendations about the management of acute pharyngitis. A literature search was conducted from January 2009 to 2023. Documents reporting recommendations on the management of acute pharyngitis were included, pertinent data were extracted, and a descriptive comparison of the different recommendations was performed. The quality of guidelines was assessed through the AGREE II instrument. Nineteen guidelines were included, and an overall moderate quality was found. Three groups can be distinguished: one group supports the antibiotic treatment of group A β-hemolytic Streptococcus (GABHS) to prevent acute rheumatic fever (ARF); the second considers acute pharyngitis a self-resolving disease, recommending antibiotics only in selected cases; the third group recognizes a different strategy according to the ARF risk in each patient. An antibiotic course of 10 days is recommended if the prevention of ARF is the primary goal; conversely, some guidelines suggest a course of 5–7 days, assuming the symptomatic cure is the goal of treatment. Penicillin V and amoxicillin are the first-line options. In the case of penicillin allergy, first-generation cephalosporins are a suitable choice. In the case of beta-lactam allergy, clindamycin or macrolides could be considered according to local resistance rates. Conclusion: Several divergencies in the management of acute pharyngitis were raised among guidelines (GLs) from different countries, both in the diagnostic and therapeutic approach, allowing the distinction of 3 different strategies. Since GABHS pharyngitis could affect the global burden of GABHS disease, it is advisable to define a shared strategy worldwide. It could be interesting to investigate the following issues further: cost-effectiveness analysis of diagnostic strategies in different healthcare systems; local genomic epidemiology of GABHS infection and its complications; the impact of antibiotic treatment of GABHS pharyngitis on its complications and invasive GABHS infections; the role of GABHS vaccines as a prophylactic measure. The related results could aid the development of future recommendations. What is Known:• GABHS disease spectrum ranges from superficial to invasive infections and toxin-mediated diseases.• GABHS accounts for about 25% of sore throat in children and its management is a matter of debate. What is New:• Three strategies can be distinguished among current GLs: antibiotic therapy to prevent ARF, antibiotics only in complicated cases, and a tailored strategy according to the individual ARF risk.• The impact of antibiotic treatment of GABHS pharyngitis on its sequelae still is the main point of divergence; further studies are needed to achieve a global shared strategy.

show abstract

Worldwide comparison of treatment guidelines for sore throat

Coutinho

Duerden

Sessa³

et al. 2021

Int. J. Clin. Pract.

View full text Add to dashboard Cite

Introduction Sore throat (acute pharyngitis) is globally one of the most frequent reasons for seeking healthcare. Its etiology is mostly viral. In 15%‐30% of cases, group A streptococci (GAS) are detected, which may cause acute rheumatic fever. We have done a worldwide systematic review to compare diagnostic and therapeutic guidelines across countries and regions. Previous reviews of sore throat guidelines were limited to specific regions and/or language; this is the first global review. Materials and Methods Searches were performed in MEDLINE, EMBASE and COCHRANE (key words: sore throat, pharyngitis, tonsillitis or pharyngotonsillitis, and management, guidance, guideline or recommendation) and on the web sites of major health authorities and associated institutions from Africa, Asia, Europe, Middle East, North America, Oceania and South America. Results Thirty‐six guidelines were identified from 26 countries. Most common are recommendations relying on the symptom‐ and age‐based Centor or McIsaac scores. However, antibiotic treatment may be based on other symptomatic criteria; in the most extreme approach just sore throat in children. The recommendation of GAS‐specific diagnostic tests is mainly limited to countries where such tests are readily available, although some countries choose not to use them. Penicillins are consistently recommended as first‐line antibiotics. By contrast, guidance for symptomatic treatment is variable and mostly sparse or missing. African countries without sore throat guidelines and Asian countries bypassing them are afflicted by rising antibiotic resistance. Conclusion The availability of sore throat guidelines varies considerably by region and country. Moreover, important divergence is found among the guidelines regarding diagnostic and treatment criteria. This may be explained by the historical background or adoption of external guidelines, rather than local incidences of GAS infections or acute rheumatic fever. Absence of recommendations on symptomatic treatment in many guidelines is concerning, and raises issues about antimicrobial stewardship, as this should be the mainstay of sore throat management, rather than antibiotics.

show abstract

Pediatrician’s approach to diagnosis and management of group A streptococcal pharyngitis

Cited by 10 publications

References 12 publications

A Review of Streptococcus pyogenes: Public Health Risk Factors, Prevention and Control

A Review of Streptococcus pyogenes: Public Health Risk Factors, Prevention and Control

Acute pharyngitis in children and adults: descriptive comparison of current recommendations from national and international guidelines and future perspectives

Worldwide comparison of treatment guidelines for sore throat

Contact Info

Product

Resources

About