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Streptococcal pharyngitis in children: to treat or not to treat?

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Abstract

Controversy remains about the need for antibiotic therapy of group A streptococcal (GAS) pharyngitis in high-resource settings. Guidelines on the management of GAS pharyngitis differ considerably, especially in children. We performed a literature search on the diagnosis and treatment of GAS pharyngitis in children and compared different guidelines with current epidemiology and the available evidence on management. Some European guidelines only recommend antibiotic treatment in certain high-risk patients, while many other, including all American, still advise antimicrobial treatment for all children with GAS pharyngitis, given the severity and re-emerging incidence of complications. Empirical antimicrobial treatment in children with sore throat and a high clinical suspicion of GAS pharyngitis will still result in significant overtreatment of nonstreptococcal pharyngitis. This is costly and leads to emerging antibiotic resistance. Early differential diagnosis between viral and GAS pharyngitis, by means of a ‘rapid antigen detection test’ (RADT) and/or a throat culture, is therefore needed if ‘pro treatment’ guidelines are used. Conclusion: Large scale randomized controlled trials are necessary to assess the value of antibiotics for GAS pharyngitis in high-resource countries, in order to achieve uniform and evidence-based guidelines. The severity and the possibly increasing incidence of complications in school-aged children suggests that testing and treating proven GAS pharyngitis can still be beneficial.

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Abbreviations

GAS:

Group A streptococcal

RADT:

Rapid antigen detection test

NNT:

Number needed to treat

RCT:

Randomized controlled trial

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The authors have no conflicts of interest, nor have any of them been prompted or paid with regard to this article.

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Authors and Affiliations

  1. Department of Pediatrics, University of Leuven, Herestraat 49, 3000, Leuven, Belgium

    Daan Van Brusselen

  2. Institute of Tropical Medicine, Antwerp, Belgium

    Erika Vlieghe

  3. Department of Infectious Diseases, University of Antwerp, Antwerp, Belgium

    Erika Vlieghe

  4. Department of Pediatric Infectious Diseases, Ghent University Hospital, Ghent, Belgium

    Petra Schelstraete

  5. Department of Pediatrics, GZA Hospitals Sint-Vincentius, Antwerp, Belgium

    Frederic De Meulder

  6. Department of Pediatrics, GZA Hospitals Sint-Augustinus, Antwerp, Belgium

    Christine Vandeputte

  7. Department of Pediatrics, Heilig Hart Hospital, Lier, Belgium

    Kristien Garmyn

  8. Department of Clinical Biology, Heilig Hart Hospital, Lier, Belgium

    Wim Laffut

  9. Department of Pediatric Emergency Medicine, Ghent University Hospital, Ghent, Belgium

    Patrick Van de Voorde

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  1. Daan Van Brusselen
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Correspondence to Daan Van Brusselen.

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Van Brusselen, D., Vlieghe, E., Schelstraete, P. et al. Streptococcal pharyngitis in children: to treat or not to treat?. Eur J Pediatr 173, 1275–1283 (2014). https://doi.org/10.1007/s00431-014-2395-2

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