No more antibiotics for strept?

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styphon

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In an article regarding the use of clinical rules to guide rapid strept testing, they suggest that maybe antibiotics for strept in North American and western Europe is an outdated idea.

EXCERPT: "Our study focused on diagnostic accuracy, assuming that patients with streptococcal pharyngitis would benefit from receiving antibiotics," Dr. Cohen said. "However, in high-income settings such as Western Europe and North America, acute rheumatic fever and rheumatic heart disease became extremely rare. In this context, the rationale for treating streptococcal pharyngitis with antibiotics is not anymore to avoid such non-suppurative complications. The goals of antibiotic treatment are now to reduce the duration and intensity of symptoms, to avoid suppurative complications such as quinsy, and to avoid spreading the germ. However, because high-quality evidence is lacking to support the use of antibiotics to pursue these goals, some scientific and medical societies such as the Dutch ones do not recommend any longer antibiotics in children with pharyngitis, even if due to group A streptococcus.""

STUDY/PAPER LINK: http://www.cmaj.ca/content/early/2014/12/08/cmaj.140772

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Obvious thought: Is the occurrence of rheumatic heart disease in these high-income areas "extremely rare" because of aggressive treatment of GAS pharyngitis? I haven't read the study yet; sorry if they answered that in there.
 
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Until we have a decent RCT showing no decrease in symptom duration, I'm still going to treat as having strep sucks. Plus, its either penicillin or a z-pak (if pen allergic), 2 antibiotics with otherwise fairly limited uses these days.
 
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