Don’t hesitate to give antibiotics to treat Strep A, GPs said

Don’t wait until “final” symptoms of strep A develop before considering antibiotics, doctors have been urged.

The vast majority of Strep A infections are easily treated with antibiotics, with penicillin being the preferred treatment in the UK.

However, the bacterial infection can quickly escalate, leading to scarlet fever or, in rare cases, a serious infection called invasive group A streptococcus (iGAS).

Six children under the age of 10 have now died from iGAS in the UK.

Experts warn against treating young patients as early as possible.

Professor Penny Ward, of the Faculty of Pharmaceutical Medicine, expressed concern that if children only show early signs, such as a fever or cough, doctors might dismiss cases of Strep A as winter viral illnesses like the flu or cold.

“Classic signs of Strep A not immediately apparent”

“It seems that the message that many winter diseases are overwhelmingly viral has been taken a little too seriously, and perhaps the classic signs of Strep A aren’t immediately obvious in these children — things like a sore throat, a rash, a fever,” she said.

In the early stages of the disease, viral and bacterial illnesses are “indistinguishable,” and the vast majority of childhood illnesses are viral, she added.

“[It’s] It’s only when they have definite symptoms like a sore throat, swollen glands, tongue coating or skin rash that people will start thinking about something other than a viral disease,” she said.

“Right now, given the disproportionate prevalence of strep in schools and preschools, general practitioners should be asking themselves, ‘Could it be strep?'”

She added: “[Doctors] should be wondering if this could be streptococci, if we’ve had cases on the ground and if so, penicillin won’t do any harm and might do some good.”

But Professor Damian Roland, specialist in pediatric emergency medicine, said: “Parents of children who appear to have a runny nose with a fever and who do not have a widespread rough-feeling rash should not be overly concerned. You should handle your child as usual – treat stress with acetaminophen and keep them hydrated.

“Medical help should be sought for those with a high fever, sore throat and rash. However, it is really important to remember that we know that many children will clear this infection on their own without antibiotics.”

Figures from the UK Health Security Agency show there were 2.3 cases of iGAS per 100,000 children aged one to four in England this year, compared with an average of 0.5 in the pre-pandemic period (2017 to 2019) .

Cases in five to nine year olds have also increased to 1.1 from 0.3 per 100,000.

“Prompt treatment can save lives”

The agency said that early detection and prompt treatment of patients with iGAS can be “life-saving.”

Scientists have raised concerns that lockdown and a lack of mixing have left some young children without immunity to the bacteria.

dr Simon Clarke, a microbiologist at the University of Reading, said: “It seems to me that, as we are currently seeing with flu, a lack of mixing may have led to a drop in population-wide immunity, which could increase transmission, particularly in school-age children .”

The rise in cases comes as GPs are also working to reduce the number of inappropriate antibiotic prescriptions to combat the rise in antibiotic-resistant superbugs.

Throat swabs can be taken to test for the infection, but it can take some time for these to be sent back from the labs.

“The problem is with very young children, it can be a really fast progressive disease,” Prof Ward said.

Referring to her own experience as a GP, she said: ‘You could play it safe and still prescribe penicillin. But of course that has been strongly discouraged in the recent past.”

Boy, three, dies in emergency room after two-hour wait

It comes as The Telegraph reported that a three-year-old boy died from the infection after waiting two hours in the emergency room.

His father, a consulting hematologist who requested anonymity, urged patients to “insist that their child be seen immediately” if they have symptoms and are “uncomfortable with breathing problems.”

Ayyub, who attended St John’s Primary School and Nursery School in Ealing, had been unwell with a high fever for three days when his father took him to hospital.

“I had to wait two hours before he was seen, but when the nurse saw him, they immediately took him to the treatment area. It’s very difficult to know if [getting seen earlier] would have changed the outcome,” he said. But he added that every minute waiting for treatment “everything comes up.”

The three-year-old died 10 hours after being rushed to hospital.

The Royal College of Paediatrics and Child Health (RCPCH) has also urged doctors to “think about group A strep” due to the high number of circulating infections.

Emergency public health measures

In a note to paediatricians, the RCPCH said: “In clinical situations suggestive of group A streptococcal infection (particularly in the presence of concomitant viral infection), empirical treatment with appropriate antibiotics is recommended, along with a throat swab.”

Doctors should also urgently notify the UKHSA of any infections to “facilitate immediate public health action including contact tracing,” it said.

This year has seen an increase in rare iGAS, particularly in children under 10, with five deaths of under-10s in England since September

A separate case was reported in Wales, bringing the national number to six

A seventh case of a 12-year-old boy from London was reported on Saturday, but the UKHSA does not routinely release data on iGAS deaths in under-18s, so it is not included in the official figures

Parents have been told to “use your own judgement” if your child seems seriously unwell and to contact NHS 111 or your GP if they are getting worse, not eating or showing signs of dehydration

If a child is having trouble breathing, their tongue or lips are blue, and they’re limp and won’t wake up, call 999 or go to the emergency room.

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