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Initial Antibiotic Choice in the Treatment of Group A Streptococcal Pharyngitis and Return Visit Rates
Courtney A Gidengil1, Benjamin A Kruskal2, Grace M Lee3
1RAND Corporation Division of Infectious Diseases, Boston Children's Hospital Harvard Medical School gidengil@rand.org.
Insights
Retreatment for Group A Streptococcal (GAS) pharyngitis in children was uncommon. Initial treatment with amoxicillin or penicillin was associated with higher odds of retreatment, suggesting a need to consider community antibiotic resistance.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Group A Streptococcal (GAS) pharyngitis is a common childhood infection.
- Clinical treatment failure, indicated by return visits, is a concern for GAS pharyngitis.
- Understanding factors influencing retreatment rates is crucial for effective management.
Purpose of the Study:
- To determine the incidence of return visits for children diagnosed with GAS pharyngitis.
- To assess if initial antibiotic choice (amoxicillin vs. penicillin) impacts GAS pharyngitis retreatment rates.
Main Methods:
- Retrospective cohort study of 5533 children (0-17 years) with positive GAS tests.
- Analyzed 6585 eligible visits, defining retreatment as a follow-up visit within 1-4 weeks.
- Validated cases through chart review of 500 selected episodes.
Main Results:
- Amoxicillin or penicillin was prescribed in 76.1% of initial visits.
- Retreatment for GAS pharyngitis occurred in 5.8% of initial treatments.
- Children initially treated with amoxicillin or penicillin had 1.51 times higher odds of retreatment, even after adjustments.
Conclusions:
- Retreatment for GAS pharyngitis is infrequent but linked to amoxicillin/penicillin use.
- The study highlights the need to balance individual treatment with community antibiotic resistance concerns.
- Further research should explore the role of GAS carriage in treatment outcomes.
Background:
Our objectives were to describe the incidence of return visits for children with Group A Streptococcal (GAS) pharyngitis (ie, clinical treatment failure) and to assess whether initial treatment with amoxicillin or penicillin was associated with the rate of retreatment for GAS pharyngitis.
Methods:
This analysis was a retrospective cohort study of 5533 children 0-17 years from a multisite practice. Eligible visits (n = 6585) were associated with a positive test for GAS, receipt of antibiotics within 7 days, no allergies to penicillins or cephalosporins, and no codiagnoses requiring antibiotic treatment. Retreatment for GAS pharyngitis was defined as an index visit followed by another visit within 1-4 weeks. Five hundred episodes (250 treatment failures and 250 controls) were randomly selected for chart review to validate cases.
Results:
Amoxicillin or penicillin was the initial antibiotic treatment at 76.1% of visits, and retreatment for GAS pharyngitis occurred after 5.8% of initial visits. Children initially prescribed amoxicillin or penicillin had higher odds of retreatment of GAS pharyngitis even after adjusting for age, sex, symptoms, and community-level covariates such as race, income, and education (odds ratio, 1.51; 95% confidence interval, 1.07-2.13).
Conclusions:
Retreatment for GAS pharyngitis was uncommon and associated with receipt of amoxicillin or penicillin, although the impact of GAS carriage is unknown. Recommendations for initial treatment of GAS pharyngitis should reflect both individual and societal considerations, including the potential impact on antibiotic resistance in the community.
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