STREPTOCOCCUS PHARYNGOTONSILLITIS, ANTIBIOTIC RESPONSE TIMES AND IMPLICATIONS FOR CURRENT PRACTICE

An increase in Group A Streptococcal (GAS) infections higher than seasonally expected levels has been recently reported. Since GAS infections and correlated bacterial diffusion always start from an index case, adopting public health strategies based on ready isolation and treatment of GAS cases has become a relevant problem in the disease management. A systematic review recently published in Eurosurveillance aimed to estimate the pooled proportion of individuals who remained GAS throat culture-positive at set intervals after initiation of antibiotics. It was shown that antibiotic therapy acts on GAS leading to both clinical and microbiological recovery within 24 hours. This was confirmed for all the proven antibiotics, with amoxicillin remaining the drug of choice. Consequently, the child can return to school as early as the day after the beginning of the antibiotic therapy, without risks of infection for the community. About the 10% of children can maintain a positive swab after the start of antibiotic therapy: they are the asymptomatic GAS carriers and they are not to be chased. Furthermore, to avoid mistakes, asymptomatic children should not undergo GAS throat swab so as not to receive further and useless antibiotic therapies.