GPS urged not to delay giving antibiotics to treat Strep A

Concerns that family doctors may be dismissing possible cases as common winter viruses such as flu

DOCTORS have been told not to wait for “definitive” symptoms of Strep A to develop before considering antibiotics.

The majority of Strep A infections can be treated with antibiotics, with penicillin the preferred course of medication.

However, the bacterial infection can escalate quickly, leading to scarlet fever or, in rare cases, a severe infection called invasive Group A Strep (IGAS).

Six children aged under 10 have now died from IGAS in the UK and experts have warned that giving young patients treatment as early as possible is vital.

Prof Penny Ward, of the Faculty of Pharmaceutical Medicine in London, raised concerns that doctors may be dismissing cases of Strep A as viral winter illnesses, such as flu or the common cold, if children are only presenting with early signs like a fever or cough.

“It does seem that the message that a lot of winter illnesses are predominantly viral may have been taken a little bit too seriously, and perhaps the classic signs of Strep A are not immediately obvious in these children – things like sore throat, rash, fever,” she said.

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

“[It’s] only if they present with definitive symptoms like sore throats, swollen glands, coating of the tongue, rash, that people will start thinking about something other than a viral illness,” she said.

“At the moment, clearly with the higher than average spread of Strep through schools and nurseries, GPS should generally be asking themselves ‘could this be Strep... have we had cases locally?’ and, if so, penicillin will not harm and may do good.”

However, Prof Damian Roland, consultant in paediatric emergency medicine at University Hospital of Leicester NHS Trust, said: “Parents of Children who [have] runny noses with a fever and without a widespread rash with a rough feel shouldn’t be too alarmed.

“They should manage their child as normal – treating distress with paracetamol and keeping them hydrated.

“For those with high fever, sore throat and rash, then medical help should be sought. However, it’s really important to remember that we know lots of children clear this infection themselves, even without antibiotics.”

UK Health Security Agency (UKHSA) figures show there have been 2.3 cases of IGAS per 100,000 children aged one to four so far this year in England, compared with an average of 0.5 in the prepandemic seasons (2017 to 2019).

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

The UKHSA said early recognition and prompt initiation of treatment for patients with IGAS can be “life-saving”.

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

Dr Simon Clarke, a microbiologist at the University of Reading, said: “It strikes me that, as we are seeing with flu at the moment, lack of mixing may have caused a drop in [immunity] that could increase transmission, particularly in school-age children.”

The increase in cases comes as GPS are also working towards reducing the number of inappropriate prescriptions for antibiotics that are made in order to tackle the rise in antibiotic resistant superbugs.

“The problem is in very young children. It can be a really, rapidly progressive illness,” Prof Ward said.