GPs warned to have ‘low threshold’ for antibiotics in potential strep A infections

General practitioners have been advised to “have a low threshold” for prescribing antibiotics for children presenting with symptoms associated with group A strep infections.

UK public health officials issued the advice on primary care, emergency and pediatric services amid concerns over high levels of infections and the deaths of six children since September.

GP visits for scarlet fever and illness notifications are rising more steeply than expected for this time of year, as are cases of invasive group A strep, although less pronounced, the The UK Health Insurance Agency has warned.

Officials are also investigating an increase in lower respiratory tract group A strep infections, particularly empyema, in children in recent weeks.

In an urgent letter to GPs, the UKHSA said: “Given the unusually high level of GAS (Group A Streptococcus) and viral co-circulation in the community, healthcare professionals are asked to have a low threshold for consider and empirically prescribe antibiotics to children”. presenting characteristics of GAS infection, even when secondary to viral respiratory diseases.’

He said that parents of children with viral infections such as the flu or chickenpox should be counseled about signs that might suggest a secondary bacterial infection.

“GPs should maintain a low threshold for prompt referral to secondary care for any child presenting with persistent or worsening symptoms,” he continued.

According to the letter, a “high burden of co-circulating viral infections may be contributing to increased severity and complications through co-infection.”

And the GP should “consider taking a throat swab to help with differential diagnosis or if the patient is thought to be part of an outbreak (to confirm etiology), allergic to penicillin (to determine antimicrobial susceptibility) or in regular contact with vulnerable people.

A total of 4,622 notifications of scarlet fever were received from week 37 to 46 of this season (2022 to 2023) in England, with 851 notifications received in week 46 compared to an average of 1,294 (range 258 to 2,008) for this season. same period (weeks 37 to 46) in the previous five years, UKHSA figures show.

There is considerable variation in England with the highest rates observed in the North West.

Laboratory notifications of invasive group A strep disease are also higher than seen in the last five years with 509 compared to 248. The highest rates to date have been reported in Yorkshire and Humberside.

In a report published on Friday, outlining current disease trends, the UKHSA also advised: “Clinicians should remain aware of potential increases in invasive disease and maintain a high index of suspicion in relevant patients and provide advice on safety nets as appropriate, as soon as possible”. recognition and prompt initiation of specific and supportive therapy for patients with iGAS infection may be life-saving.’

Professor Adam Finn, professor of pediatrics at the University of Bristol, said if infections were diagnosed earlythey can usually be effectively treated with penicillin.

“Many infections became rarer during the recent pandemic restrictions and are now rapidly making a comeback as the mix normalizes. GAS is no exception and we have been seeing an increasing number of cases in recent months.’

Dr Michael Head, a senior researcher in global health at the University of Southampton, said that while public health surveillance showed an increase in cases of scarlet fever and invasive group A strep infection than would normally be seen in this time of year, all over the full-year cases were highest in 2017/18.

“After the pandemic response over the past two and a half years, we may not yet be in line with typical seasonal expectations, and we typically see natural fluctuations in disease patterns.