title: Initial Antibiotic Choice in the Treatment of Group A Streptococcal Pharyngitis and Return Visit Rates.
abstract: BACKGROUND
  Our objectives were to describe the incidence of return visits for children with Group A Streptococcal (GAS) pharyngitis (ie, clinical treatment failure) and to assess whether initial treatment with amoxicillin or penicillin was associated with the rate of retreatment for GAS pharyngitis.
  
  
  METHODS
  This analysis was a retrospective cohort study of 5533 children 0-17 years from a multisite practice. Eligible visits (n = 6585) were associated with a positive test for GAS, receipt of antibiotics within 7 days, no allergies to penicillins or cephalosporins, and no codiagnoses requiring antibiotic treatment. Retreatment for GAS pharyngitis was defined as an index visit followed by another visit within 1-4 weeks. Five hundred episodes (250 treatment failures and 250 controls) were randomly selected for chart review to validate cases.
  
  
  RESULTS
  Amoxicillin or penicillin was the initial antibiotic treatment at 76.1% of visits, and retreatment for GAS pharyngitis occurred after 5.8% of initial visits. Children initially prescribed amoxicillin or penicillin had higher odds of retreatment of GAS pharyngitis even after adjusting for age, sex, symptoms, and community-level covariates such as race, income, and education (odds ratio, 1.51; 95% confidence interval, 1.07-2.13).
  
  
  CONCLUSIONS
  Retreatment for GAS pharyngitis was uncommon and associated with receipt of amoxicillin or penicillin, although the impact of GAS carriage is unknown. Recommendations for initial treatment of GAS pharyngitis should reflect both individual and societal considerations, including the potential impact on antibiotic resistance in the community.
authors.affiliation: RAND Corporation Division of Infectious Diseases, Boston Children's Hospital Harvard Medical School gidengil@rand.org.
authors.forename: Courtney A
authors.initials: CA
authors.lastname: Gidengil
authors.affiliation: Department of Pediatrics, Harvard Medical School Harvard Vanguard Medical Associates.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Kruskal
authors.affiliation: Division of Infectious Diseases, Boston Children's Hospital Department of Population Medicine, Harvard Medical School Harvard Pilgrim Health Care Institute Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Grace M
authors.initials: GM
authors.lastname: Lee
keywords: Group A Streptococcus; Pharyngitis; Treatment