All group A strep pharyngitis in high rheumatic fever risk patients are treated.

reduce unecessary antibiotic use

guideline

High risk for RF

  • personal, family or household history of RF

  • ≥ 2:

    • Maori/PI

    • 3-35yo

    • Living in crowded circumstanses or Low SES

  • if 1 -> Low risk

Primary care of ED

  • throat swab if f/u possible

  • start 10d of emperic penicillin or amoxil or single dose IM benzathine penicillin

School sore throat clinic

  • throat swab

    • if GAS +

      • start 10d

If GAS positive

  • consider swabbing all symptomatic household members

    • in family households

      • more than 1/2 secondary cases were in 5-12yo

        • risk of secondary GAS infection 1.8x more than that of primary infection in community

      • adults less risk of developing RF but may spread

  • consider isolating at home for 24hrs after starting 10d antibiotics

  • swab all household members if:

    • ≥ 3 cases of GAS in last 3mo

    • personal/family/household history

If GAS negative

  • stop Abx

reasons to swab

  • identify GAS pharyngitis in index case

  • discontinue abx in GAS cases

    • >70% viral

  • initiate abx in following up GAS positive results

  • allow household contact tracing and intiitate appropriate treatemnt

  • reduce unnecessary abx

  • allow for surveillance

  • provide education

low risk

  • assess severity of symptoms and occupational risk

  • unwell patients have potential to develop local suppurative complications

  • throat swabbing and / or abtibiotic treatment

    • may not be routinely required for mild symptoms

      • unless:

        • patient at risk of spreading GAS

          • health care

          • rediential care

          • food handlers

          • school/EC teachers

          • students

Antibiotics

  • Penicillin V

    • empty stomach

    • Children \<20kg

      • 250mg bd or tds

    • Adolescents and adults ≥ 20kg

      • 500mg bd or tds

  • Amoxicillin

    • can be taken with fooed

    • OD 50mg/kg OD

    • weight \<30kg

      • 750mg od

    • wieght >30kg

      • 1000mg od

    • bd 25mg/kg bd

  • benzathine penicillin IM

    • \<30kg

      • 450mg (600 000IU) once

    • .>30kg

      • 900mg (1, 200, 000IU) once

  • Roxithromycin

  • Erythromycin

  • for people on benzathine penicillin im prophylaxis who are GAS positive

    • 10d course of oral penicillin or amoxicillin