Strep Accounts for 37 Percent of Pharyngitis in Children

Clinical scoring system guides appropriate antibiotic use in low-resource settings
By Lindsey Marcellin
HealthDay Reporter

MONDAY, Aug. 9 (HealthDay News) -- Group A Streptococcus (GAS) accounts for 37 percent of pediatric pharyngitis cases, though prevalence varies by age, and clinical scoring systems could reduce unnecessary antibiotic prescribing for non-GAS pharyngitis in low-resource settings, according to research published online Aug. 9 in Pediatrics.

Nader Shaikh, M.D., of the University of Pittsburgh School of Medicine, and colleagues conducted a meta-analysis of the literature to determine the prevalence of streptococcal infection among children who presented with sore throat, as well as the prevalence of streptococcal carriage in asymptomatic children. Twenty-nine articles met the inclusion criteria for the analysis. The researchers found that the pooled prevalence of GAS in children presenting with sore throat was 37 percent overall, but only 24 percent among children younger than 5 years. The overall prevalence of asymptomatic GAS carriage was 12 percent.

Laure Joachim, M.D., of the Queen Fabiola University Children's Hospital in Brussels, Belgium, and colleagues conducted a prospective study of a new, pragmatic scoring system for GAS pharyngitis diagnosis with the aim of improving upon earlier systems that were not practical for use in low-resource settings. The scoring system was designed for the purpose of decreasing inappropriate use of antibiotics for pharyngitis. The sensitivity, specificity, and positive likelihood ratio for non-GAS infections with the clinical approach was compared with throat culture or rapid antigen-detection test results. The researchers found that the use of the new clinical decision rule would have allowed for 35 to 55 percent fewer antibiotic prescriptions, with 88 percent specificity.

"Such a scoring system would of course be most helpful in community settings in which decreases in antibiotic use would be expected to be very effective," Joachim and colleagues conclude. "Although it was designed for low-resource settings, this rule should be validated with high-income, resource-rich populations as well. Our refined scoring system may serve as an important protocol to decrease unnecessary antibiotic use in the developed world as well."

Abstract - Shaikh
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Abstract - Joachim
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