Stay the Course: Targeted Evaluation, Accurate Diagnosis, and Treatment of Streptococcal Pharyngitis Prevent Acute Rheumatic Fever

Controversy has arisen during the past decade or so regarding the medical and public health management of acute group A streptococcal pharyngitis (GAS) in children and adolescents. In particular, as the incidence of acute rheumatic fever (ARF) in many developed countries has declined, the need for testing throat swabs for GAS as an essential part of the routine evaluation of acute pharyngitis in childhood has been called into question.1 In a recent “Perspective” published in Circulation, Berkley argued that the currently recommended approach in the US of “extensive throat swabbing and antibiotic administration” for streptococcal pharyngitis to reduce the risk of ARF “can hardly be justified.”2 Berkley presented 5 arguments to suppo rt his contention:1 the decline of ARF in developed countries preceded the widespread use of antibiotics and is likely related to changes in the prevalence GAS M protein types historically associated with ARF2; the military-based treatment studies have never been replicated and did not demonstrate 1 00% efficacy in preventing ARF, GAS is still endemic in developed countries despite widespread use of antibiotics, and there has not been a resurgence of ARF in developed countries that advocate withholding antibiotics3; the outbreak of ARF in Utah in the 1980s occurred due to the presence of a GAS M type (M18) previously associated with ARF, and some patients with ARF did not have a history of sore throat4; ARF is so rare in the US that “...
Source: The Journal of Pediatrics - Category: Pediatrics Authors: Tags: Commentary Source Type: research