In support of strep A testing

It has been a funny day. My support of Strep A testing in community pharmacy has been challenged to the point where I have been called unprofessional for my views. Me and strep A go a long way back and I have absolutely no love for the little bug.

It started for me as a baby – prone to strep A throat infections – except that the associated temperature led to febrile convulsions. After several trips to the A&E – fortunately we lived less than 100 yards for UCHL – they decided on a partial tonsillectomy. Operation went fine, but as a 2 ½ year old I pulled a heavy stool over on my hand in the ward. I remain grateful to the surgeon who fixed my fingers. Slightly fewer infections and fewer fits, growing out of this, but left on phenytoin and phenobarbitone as an infant. So grateful to a headmistress called Miss Herbert who was happy to take me into mainstream education, while the antiepileptics were discontinued or my life may have been very different.

I would add that I still have a love of black cherry yogurt from my childhood, but only front line pharmacists would understand this!

Roll on 10 when dear old strep A infected both my throat and chest and led to scarlet fever. You never quite forget the 48 hours in an elderly care side room, covered in calamine lotion, waiting for a side room on the paed ward to become free. I am told that the strep A infection was probably responsible for precipitating chronic urticaria. That lasted about six years – I could explain what it is like to have chronic urticaria as a teenager before selective anti-histamines and medicines like omalizumab, but you have to have it to understand. I recently met a clinical immunology specialist pharmacist at HPE Live – I told her my experience and she understood.

Fortunately I haven’t had a strep A sore throat for years. I haven’t forgotten or forgiven strep A. I appreciate that most people with a strep A sore throat would get better without treatment, but they remain infective for around 14 days. It is 2016 and we have the ability to make a proper diagnosis using a highly effective rapid antigen test and give a course of penicillin that will eliminate the organism and reduce the period of infectiousness to 24 hours. Why wouldn’t we?

Some shout antibiotic resistance, but the truth is that resistance to penicillin in strep A pneumonia has fallen by 14% over the past 4 years – thanks Phill for this.

Others ask whether there is an increase in strep A sore throats and to be honest I don’t know. However some strep A infections are reportable and from this we know that scarlet fever went through the roof a few years ago and continues to rise. Invasive strep A was up 45% last year. There are no new strains.

I can’t help it – I believe that anyone who has a sore throat should pop down to the pharmacy and ask the pharmacist. If the pharmacist considers it appropriate then they can offer a rapid antigen test, make a proper diagnosis and get you some penicillin. Go back to work or school after 24 hours knowing that you are not spreading strep A around.

I don’t know whether the NHS should fund this or if it should be considered a personal responsibility under self-care, but however it comes in I will give it my full support.

And while I am on the subject of streptococci – I am not a great fan of the group B variety. I met a lady whose life was devastated by this bug. Very soon I will be asking colleagues to help me stop this little bug from infecting babies – because we can.


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