Relationship between group A beta-hemolytic streptococcal tonsillopharyngitis and asthma.
Increasing morbidity due to asthma in children and antimicrobial resistance among human pathogens are both major public-health concerns. Frequent use of antibiotics during childhood might be a factor underlying the rising severity and prevalence of asthma and other allergic disorders. The objective of the study was to determine if pediatric patients with asthma or allergic rhinitis have an altered rate of group A beta hemolytic streptococcal (GABHS) tonsillopharyngeal infection which might support any change in guidelines for antibiotic prescription. A prospective analysis of all patients presenting a clinical feature of GABHS pharyngitis with a sore throat in two pediatric clinics located in Detroit, MI, USA and San Antonio de Areco, Buenos Aires, Argentina. Eligible patients aged between 2 and 18 years were screened for the presence of asthma and/or allergic rhinitis and administered a test (rapid strep test) and throat culture to determine GABHS infection. At the Redford Medical Center, Detroit, 500 patients met the eligibility criteria, with 168 (33.6%) having a positive strep test. At the San Antonio de Areco's Hospital, in a rural area 100 km away from Buenos Aires, 188 patients met the eligibility criteria, with 41 (21.8%) having a positive strep test or GABHS throat cultures. In both the Detroit [odds ratio (OR) = 1.36; 95% confidence interval (CI) 0.72-2.57] and Buenos Aires clinics (OR = 0.50; 95% CI 0.23-1.07), patients with asthma or allergic rhinitis were not at an increased risk for true GABHS tonsillopharyngeal infections when compared with the general pediatric population. These results suggest that children with asthma do not differ from the normal population in their risk of developing GABHS tonsillopharyngeal infection and should not be liberally prescribed antibiotics.
Del Carmen Trojavchich
Maria
M
Department of Pediatrics, San Antonio de Areco General Hospital, Buenos Aires, Argentina. mctroja@areconet.com.ar
Crisci
Carlos D
CD
Shafa
Mehrdad
M
Rybicki
Benjamin A
BA
D000234:Adenoids / Q000382:microbiology*; D000293:Adolescent; D001118:Argentina / Q000453:epidemiology; D001249:Asthma / Q000175:diagnosis / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D016017:Odds Ratio; D010612:Pharyngitis / Q000175:diagnosis / Q000382:microbiology*; D011446:Prospective Studies; D012221:Rhinitis, Allergic, Perennial / Q000175:diagnosis / Q000382:microbiology; D013223:Statistics as Topic; D013290:Streptococcal Infections / Q000382:microbiology*; D013297:Streptococcus pyogenes; D014069:Tonsillitis / Q000175:diagnosis / Q000382:microbiology*; D014481:United States / Q000453:epidemiology