Meta-analysis of trials of streptococcal throat treatment programs to prevent rheumatic fever.
BACKGROUND
Rheumatic fever (RF) is the commonest cause of pediatric heart disease globally. Penicillin for streptococcal pharyngitis prevents RF. Inequitable access to health care persists.


OBJECTIVE
To investigate RF prevention by treating streptococcal pharyngitis in school- and/or community-based programs.


METHODS
Medline, Old Medline, the Cochrane Library, DARE, Central, NHS, EED, NICE, NRMC, Clinical Evidence, CDC website, PubMed, and reference lists of retrieved articles. Known researchers in the field were contacted where possible.


METHODS
Randomized, controlled trials or trials of before/after design examining treatment of sore throats in schools or communities with RF as an outcome where data were able to be pooled for analysis. Two authors examined titles, abstracts, selected articles, and extracted data. Disagreements were resolved by consensus. QUANTITATIVE ANALYSIS TOOL: Review Manager version 4.2 to assess pooled relative risks and 95% confidence intervals.


RESULTS
Six studies (of 677 screened) which met the criteria and could be pooled were included. Meta-analysis of these trials for RF control produced a relative risk of 0.41 (95% CI: 0.23-0.70). There was statistical heterogeneity (I = 70.5%). Hence a random effects analysis was conducted.


CONCLUSIONS
Many studies were poor quality. Title and available abstracts of non-English studies were checked. There may be publication bias. This is the best available evidence in an area with imperfect information.


CONCLUSIONS
It is expected acute RF cases would diminish by about 60% using a school or community clinic to treat streptococcal pharyngitis. This should be considered in high-risk populations.
Lennon
Diana
D
Community Paediatrics, University of Auckland, Auckland, New Zealand. d.lennon@auckland.ac.nz
Kerdemelidis
Melissa
M
Arroll
Bruce
B
D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D010612:Pharyngitis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D016032:Randomized Controlled Trials as Topic; D012213:Rheumatic Fever / Q000517:prevention & control*; D012572:School Health Services; D013290:Streptococcal Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology