Wikipedia
Group A β-hemolytic streptococcus (Streptococcus pyogenes, or GAS) is a form of β-hemolytic Streptococcus bacteria. It is a gram positive bacteriaum responsible for a wide range of both invasive and non-invasive infections.
Wikipedia
In this post, I just wish to highlight the power of FOAM to answer and discuss a clinical question. What started off as a post on Diagnostics and Likelihoods ratios for Streptococcal Pharyngitis, transgressed on to a discussion about treatment and management.
[View the story "Antibiotics and Streptococal Pharyngitis" on Storify ]
Antibiotics and Streptococal Pharyngitis
Storified by Aaron Sparshott · Tue, Feb 26 2013 05:13:18
The Post that started the conversation.
Does this patient have strep throat? And I might ask: who cares if they do? http://www.thennt.com/lr/streptococal-pharyngitis/ H&P components not helpful by themselvesGraham Walker
Streptococal Pharyngitis | TheNNTQuick Summaries of Evidence-Based Medicine
@grahamwalker I love LRs...but the challenge is determining where to start. I.e., what's the pretest in our selected ED peds population?Ryan Radecki
Antibiotics for Strep.
@grahamwalker I work in an extremely high strep community with lots of Rheum heart disease. Still unconvinced that rx with ABs make any diffCasey Parker
@broomedocs @grahamwalker what?! You dont think Bicillin prophylaxis works?Minh Le Cong
@rfdsdoc @grahamwalker bicillin works as secondary prophylaxis But throwing ABs at every sore throat doesn't prevent RhHD in my readingCasey Parker
@broomedocs @rfdsdoc @grahamwalker EMRAP this month has excellent piece on facts & myths of strep; all of which Dr. Neuman has stated 4 yrsHaney Mallemat
Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis.
@broomedocs @grahamwalker http://www.ncbi.nlm.nih.gov/pubmed/15927077Minh Le Cong
Acute Renal Failure
@rfdsdoc @broomedocs @grahamwalker some compelling argument that strains in modern/hygienic places don't lead to ARFSeth Trueger
@EMtraveller @rfdsdoc @broomedocs @grahamwalker ARF is terrible- but if abx don't help in some areas they can only hurtSeth Trueger
@MDaware @EMtraveller @broomedocs @grahamwalker have you actually seen ARF and a 4 yo kid needing heart valve repair? Me seen too many..Minh Le Cong
@rfdsdoc @MDaware @broomedocs @grahamwalker I never forget 13yo ATSI at clinic, routine check *woosh woosh*, only 100m flat walk b4 fatigueChris Edwards
@MDaware @rfdsdoc @broomedocs @grahamwalker have my 'city' centor criteria then my rural ATSI 'script already written' methodChris Edwards
@rfdsdoc @emtraveller @broomedocs @grahamwalker it's pretty terrible but doesn't really happen here outside of select at risk populationsSeth Trueger
@rfdsdoc @emtraveller @broomedocs @grahamwalker do abx prevent PSGN? I thought no. also pcn doesn't prevent spider bites.Seth Trueger
@MDaware @EMtraveller @broomedocs @grahamwalker ok getting bit off topic but yes some studies to suggest pcn to contacts can prevent PSGNMinh Le Cong
@MDaware @rfdsdoc @emtraveller @broomedocs @grahamwalker what's the point of trying to prevent a benign self-limited (v rare) disease? PSGNmovinmeat
@MDaware @EMtraveller @broomedocs @grahamwalker http://health.nt.gov.au/library/scripts/objectifyMedia.aspx?file=pdf/10/84.pdf&siteID=1&str_title=Acute%20Post-Streptococcal%20Glomerulonephritis.pdfMinh Le Cong
@rfdsdoc @movinmeat @emtraveller @broomedocs @grahamwalker yes strep is PCN sens but more PCN-> other resistenceSeth Trueger
@MDaware @movinmeat @EMtraveller @broomedocs @grahamwalker well what do you propose for secondary prevention of ARF then?Minh Le Cong
@rfdsdoc @movinmeat @emtraveller @broomedocs @grahamwalker modern hygiene?Seth Trueger
@rfdsdoc @movinmeat @emtraveller @broomedocs @grahamwalker if at risk population (developing world, recent immigrant, Queenslander) then PCNSeth Trueger
@rfdsdoc @broomedocs @grahamwalker NZ guidelines support 1˚ prev of ARF with pcn 4 GAS in high risk regions. Some towns swab & rx asympt GASRochelle
@rfdsdoc @broomedocs @grahamwalker abx for ARF also disputed (from http://rhdaustralia.org.au) http://pic.twitter.com/Vzwu11UeLWWilliam Sargent
Some Further Reading
Australian Therapeutic Guidelines
The therapeutic goals used to justify antibiotic treatment for pharyngitis/tonsillitis are:
to prevent nonsuppurative complications (eg acute rheumatic fever, acute glomerulonephritis)
to prevent suppurative complications (eg acute otitis media, quinsy, acute sinusitis)
to shorten the illness.
Short-term late-generation antibiotics versus longer term penicillin for acute streptococcal pharyngitis in children - The Cochrane Library - Altamimi - Wiley Online LibraryBackground The standard duration of treatment for children with acute group A beta hemolytic streptococcus (GABHS) pharyngitis with oral ...
Different antibiotic treatments for group A streptococcal pharyngitis - The Cochrane Library - van Driel - Wiley Online LibraryBackground Antibiotics provide only modest benefit in treating sore throat, although effectiveness increases in participants with positiv...
Below is a short summary of some of the tweets that I managed to capture. I've also added a bit of further reading for the Australian readers. One final lesson that can be learnt from this discussion, is that management is often guided by the population you are treating and the resources available to you.
[View the story "Antibiotics and Streptococal Pharyngitis" on Storify ]
Antibiotics and Streptococal Pharyngitis
Storified by Aaron Sparshott · Tue, Feb 26 2013 05:13:18
The Post that started the conversation.
Does this patient have strep throat? And I might ask: who cares if they do? http://www.thennt.com/lr/streptococal-pharyngitis/ H&P components not helpful by themselvesGraham Walker
Streptococal Pharyngitis | TheNNTQuick Summaries of Evidence-Based Medicine
@grahamwalker I love LRs...but the challenge is determining where to start. I.e., what's the pretest in our selected ED peds population?Ryan Radecki
Antibiotics for Strep.
@grahamwalker I work in an extremely high strep community with lots of Rheum heart disease. Still unconvinced that rx with ABs make any diffCasey Parker
@broomedocs @grahamwalker what?! You dont think Bicillin prophylaxis works?Minh Le Cong
@rfdsdoc @grahamwalker bicillin works as secondary prophylaxis But throwing ABs at every sore throat doesn't prevent RhHD in my readingCasey Parker
@broomedocs @rfdsdoc @grahamwalker EMRAP this month has excellent piece on facts & myths of strep; all of which Dr. Neuman has stated 4 yrsHaney Mallemat
Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis.
@broomedocs @grahamwalker http://www.ncbi.nlm.nih.gov/pubmed/15927077Minh Le Cong
Acute Renal Failure
@rfdsdoc @broomedocs @grahamwalker some compelling argument that strains in modern/hygienic places don't lead to ARFSeth Trueger
@EMtraveller @rfdsdoc @broomedocs @grahamwalker ARF is terrible- but if abx don't help in some areas they can only hurtSeth Trueger
@MDaware @EMtraveller @broomedocs @grahamwalker have you actually seen ARF and a 4 yo kid needing heart valve repair? Me seen too many..Minh Le Cong
@rfdsdoc @MDaware @broomedocs @grahamwalker I never forget 13yo ATSI at clinic, routine check *woosh woosh*, only 100m flat walk b4 fatigueChris Edwards
@MDaware @rfdsdoc @broomedocs @grahamwalker have my 'city' centor criteria then my rural ATSI 'script already written' methodChris Edwards
@rfdsdoc @emtraveller @broomedocs @grahamwalker it's pretty terrible but doesn't really happen here outside of select at risk populationsSeth Trueger
@rfdsdoc @emtraveller @broomedocs @grahamwalker do abx prevent PSGN? I thought no. also pcn doesn't prevent spider bites.Seth Trueger
@MDaware @EMtraveller @broomedocs @grahamwalker ok getting bit off topic but yes some studies to suggest pcn to contacts can prevent PSGNMinh Le Cong
@MDaware @rfdsdoc @emtraveller @broomedocs @grahamwalker what's the point of trying to prevent a benign self-limited (v rare) disease? PSGNmovinmeat
@MDaware @EMtraveller @broomedocs @grahamwalker http://health.nt.gov.au/library/scripts/objectifyMedia.aspx?file=pdf/10/84.pdf&siteID=1&str_title=Acute%20Post-Streptococcal%20Glomerulonephritis.pdfMinh Le Cong
@rfdsdoc @movinmeat @emtraveller @broomedocs @grahamwalker yes strep is PCN sens but more PCN-> other resistenceSeth Trueger
@MDaware @movinmeat @EMtraveller @broomedocs @grahamwalker well what do you propose for secondary prevention of ARF then?Minh Le Cong
@rfdsdoc @movinmeat @emtraveller @broomedocs @grahamwalker modern hygiene?Seth Trueger
@rfdsdoc @movinmeat @emtraveller @broomedocs @grahamwalker if at risk population (developing world, recent immigrant, Queenslander) then PCNSeth Trueger
@rfdsdoc @broomedocs @grahamwalker NZ guidelines support 1˚ prev of ARF with pcn 4 GAS in high risk regions. Some towns swab & rx asympt GASRochelle
@rfdsdoc @broomedocs @grahamwalker abx for ARF also disputed (from http://rhdaustralia.org.au) http://pic.twitter.com/Vzwu11UeLWWilliam Sargent
Some Further Reading
Australian Therapeutic Guidelines
The therapeutic goals used to justify antibiotic treatment for pharyngitis/tonsillitis are:
to prevent nonsuppurative complications (eg acute rheumatic fever, acute glomerulonephritis)
to prevent suppurative complications (eg acute otitis media, quinsy, acute sinusitis)
to shorten the illness.
Short-term late-generation antibiotics versus longer term penicillin for acute streptococcal pharyngitis in children - The Cochrane Library - Altamimi - Wiley Online LibraryBackground The standard duration of treatment for children with acute group A beta hemolytic streptococcus (GABHS) pharyngitis with oral ...
Different antibiotic treatments for group A streptococcal pharyngitis - The Cochrane Library - van Driel - Wiley Online LibraryBackground Antibiotics provide only modest benefit in treating sore throat, although effectiveness increases in participants with positiv...
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