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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Why Ten Days Of Penicillin?
- Standard 10-day beta-lactam courses come from small older studies and aim for bacterial eradication.
- Shorter courses may be effective but risks and microbiome/AMR harms should be weighed in high-income settings.
Choose Beta-Lactams First
- Prefer penicillin or amoxicillin for strep; use cephalosporins or macrolides only when needed.
- Check local macrolide resistance rates before using macrolides because rates vary widely.
Penicillin Resistance Remains Rare
- No clinically significant penicillin resistance in Strep A has emerged despite decades of use.
- Penicillin-resistance mutations appear to reduce bacterial fitness and virulence, limiting their spread.