With the increased circulation of streptococcus recorded this year among children, the need for information of families also grows, starting from the reliability of the tests, the possible need for other tests, the use of antibiotics, allergies and even the times for back to school. Questions to which the pediatricians of the Italian Society of Pediatrics (Sip) offer answers in a sort of guide for parents published on the website of the scientific society.
With the end of the restrictions implemented in the pandemic, more infections by viruses and respiratory bacteria have been recorded. In particular, there have been more infections caused by group A beta-haemolytic streptococcus. At the same time, the production of the antibiotic most used in these cases, amoxicillin, has decreased, both in Italy and in Europe. Starting from these premises, the Sip infectious diseases and vaccinations technical table, led by Susanna Esposito, has drawn up a document to increase adherence to national guidelines for the appropriate use of antibiotics. The goal “is to provide parents with some answers to the most common doubts related to group A beta-haemolytic streptococcus. The main advice is to always contact the pediatrician to avoid inappropriate use of antibiotics and guarantee children the best care based on the scientific evidence”, explains Annamaria Staiano, president of Sip.
These are the questions and answers of the pediatricians:
1) Is group A beta-hemolytic streptococcus always responsible for pharyngotonsillitis? It is responsible for about 1 in 4 cases of pharyngotonsillitis and mainly affects school-age children and adolescents, with a prevalence ranging from 19% to 30% between 5 and 19 years of age. This streptococcus that causes pharyngotonsillitis is the same that causes scarlet fever.
2) What are the complications of pharyngotonsillitis? This pathology caused by streptococcus has a benign course, with resolution of the picture within 3-7 days. However, in a minority of cases, it can cause peritonsillar, parapharyngeal or retropharyngeal abscesses, otitis media, sinusitis, mastoiditis. There are also other complications such as rheumatic disease and acute post-streptococcal glomerulonephritis.
3) Is the throat swab always reliable? The reliability of the throat swab depends on the adequacy of the sample collection. The collected sample can be analyzed by rapid antigen test, culture test or molecular tests.
4) Are rapid tests sufficient for the diagnosis or do other tests need to be done? A positive or negative rapid antigen test result is sufficient for diagnosis in most cases. Blood tests (antistreptolysin level, C-reactive protein, and white blood cell count) are not recommended for the diagnosis of pharyngotonsillitis.
5) When is it necessary to swab? The execution of the swab must take place on the recommendation of the treating pediatrician to avoid erroneous diagnoses and inappropriate use of antibiotic therapy.
6) Should those who test positive for the swab always undergo antibiotic therapy? A percentage of children, from 10 to 25%, who test positive for the swab are actually carriers of beta haemolytic streptococcus A. The carrier state can last from weeks to months, but is associated with a minimal risk of complications and a low risk of transmission. Antibiotic treatment is not recommended in carrier subjects.
7) In which cases is antibiotic therapy recommended? In pediatric patients suffering from streptococcal pharyngotonsillitis or scarlet fever, antibiotic therapy is recommended for the rapid reduction of symptoms and to avoid the risk of complications. If the pharyngotonsillitis is not caused by streptococcus A, antibiotic therapy is not recommended. The recommended antibiotic of first choice is amoxicillin. In the absence of other indications (relapses, therapeutic failure) or in the absence of contraindications to amoxicillin, antibiotic therapy with amoxicillin-clavulanic acid, cephalosporins or macrolides is not recommended.
8) What to do if my child is allergic to amoxicillin? In case of allergy, suspected or confirmed, you can opt for macrolides. 2nd and 3rd generation cephalosporins should not be recommended.
9) What to do if my child has recurrent pharyngotonsillitis from Sbea after antibiotic treatment? At present, on the basis of the evidence available in the literature, it is not possible to establish a recommendation regarding the antibiotic therapy of recurrent pharyngotonsillitis caused by Sbea after treatment with amoxicillin. Only in cases where tonsillectomy is planned could alternative amoxicillin-clavulanic acid or clindamycin therapy be attempted.
10) When can the child go back to school? Resuming school in the case of streptococcal pharyngotonsillitis or scarlet fever can take place at least 24 hours after the start of antibiotic therapy and does not require a medical certificate or documentation of the negative swab.
11) What are the preventive measures? They are adequate hand hygiene, good ventilation of internal environments and the elimination of possible promiscuous behavior such as sharing utensils, glasses and personal items.
