Don’t delay giving antibiotics to treat strep A, GPs have said

Don’t wait for ‘definitive’ symptoms of strep A to develop before considering antibiotics, doctors have been urged.

The vast majority of Strep A infections can be easily treated with antibiotics, with penicillin being the preferred drug treatment in the UK.

But the bacterial infection can get worse quickly, leading to scarlet fever or, in rare cases, a serious infection called invasive group A streptococcus (iGAS).

Six children aged under 10 have now died of iGAS in the UK.

Experts have warned that it is vital to get young patients on treatment as soon as possible.

Professor Penny Ward, from the School of Pharmaceutical Medicine, has raised concerns that doctors could dismiss cases of strep A as viral winter illnesses, such as the flu or the common cold, if children only show signs symptoms such as fever or cough.

“The classic signs of strep A are not immediately obvious”

“It seems that the message that many winter illnesses are primarily viral may have been taken a little too seriously, and perhaps the classic signs of Strep A are not immediately evident in these children – things like sore throat, rash, fever,” she said.

In the early stages of the disease, viral and bacterial illnesses are “indistinguishable” and the vast majority of childhood illnesses are viral, she added.

“[It’s] only if they have definite symptoms like sore throat, swollen glands, tongue coating, rash, will people start thinking of something other than a viral illness,” she said. .

“At the moment, clearly with the higher than average spread of Strep in schools and nurseries, GPs generally should ask themselves ‘could this be Strep? “.

She added: “[Doctors] should be wondering if it could be Strep, have we had cases locally and if so penicillin won’t do any harm and may do some good.

But Professor Damian Roland, consultant in pediatric emergency medicine, said: “Parents of children who have an obvious runny nose with a fever and no generalized rash with a rough feeling should not be too alarmed. They should manage their child as usual – treating distress with paracetamol and keeping them hydrated.

“For those with a high fever, sore throat and rash, medical help should be sought. However, it is really important to remember that we know that many children clear this infection on their own, even without antibiotics.”

Figures from the UK Health Security Agency show there have been 2.3 cases of iGAS per 100,000 children aged one to four this year in England, compared to an average of 0.5 during the pre-pandemic seasons (2017 to 2019).

Cases in children aged five to nine also fell from 0.3 per 100,000 to 1.1.

“Quick treatment can save lives”

The agency said early recognition and prompt initiation of treatment for patients with iGAS can be “life-saving”.

Scientists have raised concerns that the lockdown and lack of mixing left some young children without immunity to the bacteria.

Dr Simon Clarke, a microbiologist at the University of Reading, said: ‘It strikes me that, as we are seeing now with influenza, the lack of mixing may have caused a drop in immunity across the body. population that could increase transmission, especially at school age. children.”

The rise in cases comes as GPs are also scrambling to reduce the number of inappropriate antibiotic prescriptions to tackle the rise of antibiotic-resistant superbugs.

Throat swabs can be taken to test for infection, but these may take some time to be returned from the labs.

“The problem is in very young children it can be a very rapidly progressive disease,” Professor Ward said.

Referring to her own experience as a GP, she said: ‘One could err on the side of caution and prescribe penicillin anyway. But, of course, this has been very discouraged in the recent past.

Three-year-old boy dies after two hours of waiting in emergency room

It comes as The Telegraph reported that a three-year-old boy died of the infection after waiting two hours in A&E.

Her father, a consultant haematologist who asked to remain anonymous, urged patients to ‘insist on their child being seen immediately’ if they have symptoms and are ‘sick with respiratory problems’.

Ayyub, who attended St John’s Primary and Nursery School in Ealing, had been ill for three days with a high fever when his father took him to hospital.

“I waited two hours for him to be seen, but once the nurse saw him she immediately took him to the treatment area. It is very difficult to know if [getting seen earlier] would have changed the outcome,” he said. But he added that every minute of waiting for treatment ‘it all adds up’

The three-year-old died 10 hours after going to hospital.

The Royal College of Paediatrics and Child Health (RCPCH) has also called on doctors to “think about group A strep” because of the high number of circulating infections.

Immediate Public Health Actions

In a message to paediatricians, the RCPCH said: “Empirical treatment with appropriate antibiotics is encouraged in clinical situations that suggest group A streptococcal infection (especially if there is a coexisting viral infection), as well as taking of a throat swab.

Doctors should also urgently notify the UKHSA of any infections to “facilitate immediate public health action, including contact tracing”, he said.

There has been an increase in rare iGAS this year, particularly in children under 10, with five deaths of children under 10 in England since September

A separate case has been reported in Wales, taking the national figure to six

A seventh case of a 12-year-old boy from London was reported on Saturday, but the UKHSA does not routinely publish data on iGAS deaths in people under the age of 18, so it will not be included in official figures.

Parents have been urged to ‘trust your own judgement’ if your child appears seriously ill and to seek help from NHS 111 or your GP if they are deteriorating, not eating or showing signs of dehydration.

If a child is having difficulty breathing, has a blue tongue or lips, and is limp and won’t wake up, call 999 or go to A&E.

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