Work

Effect of a Widespread Reduction in Treatment Duration for Group A Streptococcal Pharyngitis on Outcomes Including Household Transmission

Year: 2025

Type: article

Abstract: Background Shorter-course treatment for group A streptococcal (GAS) pharyngitis may be equivalent to 10 days for clinical cure but effectiveness for pharyngeal GAS eradication is uncertain. The effect on household transmission has not been examined directly. In 2022, a laboratory antimicrobial stewardship initiative drove an abrupt reduction in treatment durations for GAS pharyngitis locally. This study aimed to assess whether this had any negative effect on key treatment outcomes: clinical failure, microbiological failure, immune sequelae, and household GAS transmission. Methods Positive throat swab cultures for GAS 2 years prechange until 25 months postchange were matched to antibiotic dispensing data. Logistic models were fitted to examine associations between treatment duration and 30-day repeat antibiotic treatment, repeat GAS-positive throat swab cultures, hospitalization, incident household cases, and 90-day incidence of rheumatic fever. Results A total of 851 patients prechange and 1746 postchange were included; 31.3% prechange received ≤7 days’ treatment versus 59.0% postchange (P < .01). There were no significant differences across any outcome measure between periods. When the postchange period was examined specifically, no significant increases occurred for any outcome measure for patients receiving 0, 5, or 7 days of antibiotics versus 10 days, except higher 30-day antibiotic treatment in those initially receiving no antibiotics (15.6% vs 11.4%, P < .01). Conclusions Shorter-course treatment had no detectable negative effect on GAS pharyngitis outcomes in this population, including patients receiving no antibiotics. Short-course therapy for GAS pharyngitis has been associated with lower pharyngeal eradication; this did not translate to a detectable increase in household transmission in this real-world setting, which to our knowledge is a novel finding.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofaf323

Authors: Max Bloomfield, Hamish Reed, Sue Todd, Koen van der Werff, Michelle Balm, Tim Blackmore

Institution: Health New Zealand

Language: English

Topic: Streptococcal Infections and Treatments

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $4,053