Over the past couple of weeks I have met several people with very polarised opinions on the treatment of strep A infection.
Yesterday I met a senior GP who said that she wouldn’t treat everyone with a Strep A sore throat with an antibiotic. Even if she had the result of a rapid antigen test and was 98% sure it was a strep A infection she still wouldn’t treat everyone. The basis of the stance was that most people would get better without treatment and the treatment might reduce the symptoms by half a day, but that was all – it wasn’t worth it. She was clear that she had to reduce the use of antibiotics to reduce the risk of resistance.
That was all very well, but questions on how to reduce spread within the community was less convincingly answered. No thought about washing hands, alcoholic hand gel and staying away from schools and older people for a couple of weeks.
A week ago I met a lady from Public Health England who was very convinced that every GP who had a patient with a definitive diagnosis of Strep A would treat it. She was knowledgeable about the reporting of scarlet fever and invasive strep A infections and dealing with serious outbreaks – of which there are about 90 a year. She spoke about the risk of transfer and the value of antibiotics in reducing spread, allowing people to return to school, work or normal social interactions after 24 hours.
When I asked about resistance – she looked aghast and informed me that there has been no isolate of strep a found that is resistant to penicillin.
I do wish that people would talk. Mix evidence with knowledge, wisdom and a smattering of common sense and come up with a consensus.
So would you or would you not treat a confirmed case of strep A sore throat? And if not what advice would you give about infection control and prevention of spread.