title: Streptococcal pharyngitis in children: to treat or not to treat?
abstract: Controversy remains about the need for antibiotic therapy of group A streptococcal (GAS) pharyngitis in high-resource settings. Guidelines on the management of GAS pharyngitis differ considerably, especially in children. We performed a literature search on the diagnosis and treatment of GAS pharyngitis in children and compared different guidelines with current epidemiology and the available evidence on management. Some European guidelines only recommend antibiotic treatment in certain high-risk patients, while many other, including all American, still advise antimicrobial treatment for all children with GAS pharyngitis, given the severity and re-emerging incidence of complications. Empirical antimicrobial treatment in children with sore throat and a high clinical suspicion of GAS pharyngitis will still result in significant overtreatment of nonstreptococcal pharyngitis. This is costly and leads to emerging antibiotic resistance. Early differential diagnosis between viral and GAS pharyngitis, by means of a 'rapid antigen detection test' (RADT) and/or a throat culture, is therefore needed if 'pro treatment' guidelines are used.
  
  
  CONCLUSIONS
  Large scale randomized controlled trials are necessary to assess the value of antibiotics for GAS pharyngitis in high-resource countries, in order to achieve uniform and evidence-based guidelines. The severity and the possibly increasing incidence of complications in school-aged children suggests that testing and treating proven GAS pharyngitis can still be beneficial.
authors.affiliation: Department of Pediatrics, University of Leuven, Herestraat 49, 3000, Leuven, Belgium, daan.vanbrusselen@gmail.com.
authors.forename: Daan
authors.initials: D
authors.lastname: Van Brusselen
authors.forename: Erika
authors.initials: E
authors.lastname: Vlieghe
authors.forename: Petra
authors.initials: P
authors.lastname: Schelstraete
authors.forename: Frederic
authors.initials: F
authors.lastname: De Meulder
authors.forename: Christine
authors.initials: C
authors.lastname: Vandeputte
authors.forename: Kristien
authors.initials: K
authors.lastname: Garmyn
authors.forename: Wim
authors.initials: W
authors.lastname: Laffut
authors.forename: Patrick
authors.initials: P
authors.lastname: Van de Voorde
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D006801:Humans; D010612:Pharyngitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D017410:Practice Guidelines as Topic; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents
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