Problemi correnti
Faringotonsillite da streptococco, tempi di risposta all’antibiotico e implicazioni per la pratica corrente
Streptococcus pharyngotonsillitis, antibiotic response times and implications for current practice
Iacono A, Mambelli L, De Nardi L, Marchetti F.
Giugno 2023 - pagg. 363 -367 | DOI: 10.53126/MEB42363
Abstract
An increase in Group A Streptococcal (GAS) infections higher than seasonally expected levels has been recently reported. Since GAS infections and correlated bacterial diffusion always start from an index case, adopting public health strategies based on ready isolation and treatment of GAS cases has become a relevant problem in the disease management. A systematic review recently published in Eurosurveillance aimed to estimate the pooled proportion of individuals who remained GAS throat culture-positive at set intervals after initiation of antibiotics. It was shown that antibiotic therapy acts on GAS leading to both clinical and microbiological recovery within 24 hours. This was confirmed for all the proven antibiotics, with amoxicillin remaining the drug of choice. Consequently, the child can return to school as early as the day after the beginning of the antibiotic therapy, without risks of infection for the community. About the 10% of children can maintain a positive swab after the start of antibiotic therapy: they are the asymptomatic GAS carriers and they are not to be chased. Furthermore, to avoid mistakes, asymptomatic children should not undergo GAS throat swab so as not to receive further and useless antibiotic therapies.
Riassunto
Negli ultimi mesi abbiamo assistito ad un’epidemia di infezioni da Streptococco beta emolitico di gruppo A (SBEA) con incremento dei casi di malattie invasive. Agli inizi del 2023 sulla rivista Eurosurveillance č stata pubblicata una revisione sistematica della letteratura che aveva come obiettivo quello di valutare i tempi di negativizzazione dell’esame colturale dello SBEA dopo l’inizio della terapia antibiotica. Il risultato č che la sbatterizzazione dello SBEA a livello faringeo si ottiene in piů del 90% dei casi 24 ore dopo l’inizio della terapia antibiotica, fornendo prove a sostegno delle linee guida di sanitŕ pubblica che raccomandano l’isolamento dei bambini con faringotonsillite da SBEA o scarlattina per almeno 24 ore dopo l’inizio del trattamento; il bambino puň pertanto essere riammesso in comunitŕ il giorno successivo all’inizio della terapia antibiotica. Inoltre, non sono state evidenziate differenza di efficacia tra i vari gruppi di antibiotici testati; pertanto, la penicillina (amoxicillina) rimane il farmaco di scelta. Relativamente alta č la percentuale di resistenza dello SBEA nei confronti dei macrolidi. Il 10% dei pazienti puň continuare ad essere positivo dopo il trattamento, prevalentemente con il ceppo originale, ma si tratta di uno stato di portatore; in questi pazienti o in quelli asintomatici non bisogna eseguire controlli del tampone onde evitare frequenti errori di valutazione, talvolta con il ricorso (inutile) ad ulteriori antibioticoterapie a piů ampio spettro.
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Bibliografia
1. Marchetti F. Le recrudescenze (anche) da streptococco beta-emolitico di gruppo A. Medico e Bambino 2023;42(1):45-47. doi: 10.53126/MEB42045.
2. Oliver J, Malliya Wadu E, Pierse N, Moreland NJ, Williamson DA, Baker MG. Group A Streptococcus pharyngitis and pharyngeal carriage: a meta-analysis. PLoS Negl Trop Dis 2018;12(3):e0006335. doi: 10.1371/journal. pntd.0006335.
3. Pearson M, Fallowfield JL, Davey T, et al. Asymptomatic group A Streptococcal throat carriage in royal Marines recruits and young officers. J Infect 2017;74(6):585-589. doi: 10.1016/j.jinf.2017.03.001.
4. Spitzer J, Hennessy E, Neville L. High group A streptococcal carriage in the Orthodox Jewish community of north Hackney. Br J Gen Pract 2001;51(463):101-5.
5. Cordery R, Purba AK, Begum L, et al. Frequency of transmission, asymptomatic shedding, and airborne spread of Streptococcus pyogenes in schoolchildren exposed to scarlet fever: a prospective, longitudinal, multicohort, molecular epidemiological, contact-tracing study in England, UK. Lancet Microbe 2022;3(5):e366-e375. doi: 10.1016/S2666-5247(21)00332-3.
6. Daneman N, Green KA, Low DE, et al. Surveillance for hospital outbreaks of invasive group A streptococcal infections in Ontario, Canada, 1992 to 2000. Ann Intern Med 2007;147(4):234-41. doi: 10.7326/0003-4819-147-4-200708210-00004.
7. Breese BB, Disney FA. Factors influencing the spread of beta-hemolytic streptococcal infections within the family group. Pediatrics 1956;17(6):834-8.
8. Falck G, Kjellander J. Outbreak of group A streptococcal infection in a day-care center. Pediatr Infect Dis J 1992;11(11):914-9. doi: 10.1097/00006454-199211110-00002.
9. Feeney KT, Dowse GK, Keil AD, Mackaay C, McLellan D. Epidemiological features and control of an outbreak of scarlet fever in a Perth primary school. Commun Dis Intell Q Rep 2005;29(4):386-90.
10. Gerber MA, Baltimore RS, Eaton CB, et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis. Circulation 2009;119(11):1541-51. doi: 10.1161/CIRCULATIONAHA.109. 191959.
11. Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database Syst Rev 2013;2013(11):CD000023. doi: 10.1002/14651858.CD000023.pub4.
12. McGuire Emma, Li Ang, Collin Simon M, et al. S. Time to negative throat culture following initiation of antibiotics for pharyngeal group A Streptococcus: a systematic review and meta-analysis up to October 2021 to inform public health control measures. Euro Surveill 2023;28(15):2200573. doi: 10.2807/ 1560-7917.ES.2023.28.15.2200573.
13. Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH. Group A Streptococcal infections. Red Book: 2021-2024. Report of the Committee on Infectious Diseases, Committee on Infectious Diseases, American Academy of Pediatrics. 32nd ed, 2021.
14. Centres for Disease Control and Prevention. Group A Streptococcus infections. infection control in healthcare personnel: epidemiology and control of selected infections transmitted among healthcare personnel and patients. Atlanta (US): CDC; 2021.
15. Steer JA, Lamagni T, Healy B et al. Guidelines for prevention and control of group A streptococcal infection in acute healthcare and maternity settings in the UK. J Infect 2012;64(1):1-18. doi: 10.1016/j.jinf.2011.11. 001.
16. United Kingdom Health Security Agency. Guidelines for the public health management of scarlet fever outbreaks in schools, nurseries and other childcare settings. London: UKHSA, 2023.
17. Brook I, Gober AE. Rate of eradication of group A betahemolytic streptococci in children with pharyngo-tonsillitis by amoxicillin and cefdinir. Int J Pediatr Otorhinolaryngol 2009;73(5):757-9. doi: 10.1016/j.ijporl.2009. 02.004.
18. Snellman LW, Stang HJ, Stang JM, Johnson DR, Kaplan EL. Duration of positive throat cultures for group A streptococci after initiation of antibiotic therapy. Pediatrics 1993;91(6):1166-70.
19. Ginsburg CM, McCracken GH Jr, Steinberg JB, et al. Management of group A streptococcal pharyngitis: a randomized controlled study of twice daily erythromycin ethylsuccinate versus erythromycin estolate. Pediatr Infect Dis 1982;1(6):384-7.
20. Lester RL, Howie VM, Ploussard JH. Treatment of streptococcal pharyngitis with different antibiotic regimens. Clin Pediatr (Phila) 1974;13(3):239-42. doi: 10.1177/ 000992287401300308.
21. Stein GE, Christensen S, Mummaw N. Comparative study of clarithromycin and penicillin V in the treatment of streptococcal pharyngitis. Eur J Clin Microbiol Infect Dis 1991;10(11):949-53. doi: 10.1007/BF02005450.
22. Levine MK, Berman JD. A comparison of clindamycin and erythromycin in beta-hemolytic streptococcal infections. J Med Assoc Ga 1972;61(3):108-11.
23. Watkins VS, Smietana M, Conforti PM, Sides GD, Huck W. Comparison of dirithromycin and penicillin for treatment of streptococcal pharyngitis. Antimicrob Agents Chemother 1997;41(1):72-5. doi: 10.1128/ AAC.41.1.72.
24. Disney FADM, Higgins JE, Nolen T, Poole JM, Randolph M, Rogan MP. Comparison of once-daily cefadroxil and four-times-daily erythromycin in group A streptococcal tonsillopharyngitis. Adv Ther 1990;7(6):312-26.
25. Ryan DC, Dreher GH, Hurst JA. Estolate and stearate forms of erythromycin in the treatment of acute beta haemolytic streptococcal pharyngitis. Med J Aust 1973;1(1):20-1. doi: 10.5694/j.1326-5377.1973.tb119576.x.
26. Ginsburg CM, McCracken GH Jr, et al. Treatment of Group A streptococcal pharyngitis in children. Results of a prospective, randomized study of four antimicrobial agents. Clin Pediatr (Phila) 1982;21(2):83-8. doi: 10.1177/000992288202100203.
27. De la Garza CA, Nolen TM, Rogan MP. Cefprozil vs. erythromycin in streptococcal tonsillopharyngitis. Infect Med 1992;9:8-20.
28. Sinanian R, Ruoff G, Panzer J, Atkinson W. Streptococcal pharyngitis: a comparison of the eradication of the organism by 5- and 10-day antibiotic therapy. Curr Ther Res Clin Exp 1972;14(11):716-20.
29. Trickett PC, Dineen P, Mogabgab W. Clinical experience: respiratory tract. Trimethoprim-sulfamethoxazole versus penicillin G in the treatment of group A beta-hemolytic streptococcal pharyngitis and tonsillitis. J Infect Dis 1973;128:Suppl:693-5 p. doi: 10.1093/ infdis/128.supplement_3.s693.
30. Hoskins TW, Bernstein LS. Trimethoprim/sulphadiazine compared with penicillin V in the treatment of streptococcal throat infections. J Antimicrob Chemother 1981;8(6) :495-6. doi: 10.1093/jac/8.6.495.
31. Gerber MA, Randolph MF, DeMeo K, Feder HM Jr, Kaplan EL. Failure of once-daily penicillin V therapy for streptococcal pharyngitis. Am J Dis Child 1989;143(2):153-5. doi: 10.1001/archpedi.1989.02150140039016.
32. Krober MS, Weir MR, Themelis NJ, van Hamont JE. Optimal dosing interval for penicillin treatment of streptococcal pharyngitis. Clin Pediatr (Phila) 1990;29(11):646-8. doi: 10.1177/000992289002901105.
33. Raz R, Elchanan G, Colodner R, et al. Penicillin V twice daily vs. four times daily in the treatment of streptococcal pharyngitis. Infect Dis Clin Pract 1995;4(1):50-4.
34. Shvartzman P, Tabenkin H, Rosentzwaig A, Dolginov F. Treatment of streptococcal pharyngitis with amoxycillin once a day. BMJ 1993;306(6886):1170-2. doi: 10.1136/ bmj.306.6886.1170.
35. Lennon DR, Farrell E, Martin DR, Stewart JM. Once-daily amoxicillin versus twice-daily penicillin V in group A betahaemolytic streptococcal pharyngitis. Arch Dis Child 2008;93(6):474-8. doi: 10.1136/adc. 2006.113506.
36. Howie VM, Ploussard JH. Treatment of group A streptococcal pharyngitis in children. Comparison of lincomycin and penicillin G given orally and benzathine penicillin G given intramuscularly. Am J Dis Child 1971; 121(6):477-80. doi: 10.1001/archpedi.1971. 02100170059005.
37. Colcher IS, Bass JW. Penicillin treatment of streptococcal pharyngitis. A comparison of schedules and the role of specific counseling. JAMA 1972;222(6):657-9.
38. Pavesio D, Pecco P, Peisino MG. Short-term treatment of streptococcal tonsillitis with ceftriaxone. Chemotherapy 1988;34 Suppl 1:34-8. doi: 10.1159/000238645.
39. Murgia V, Marchetti F. Dopo quanto tempo puň rientrare a scuola un bambino con faringotonsillite da SBEA in trattamento con amoxicillina? Medico e Bambino 2015;34(9): 539-41.
40. Schwartz RH, Kim D, Martin M, Pichichero ME. A reappraisal of the minimum duration of antibiotic treatment before approval of return to school for children with streptococcal pharyngitis. Pediatr Infect Dis J 2015;34(12): 1302-4. doi: 10.1097/INF.0000000000000883.
41. Tadesse M, Hailu Y, Biset S, Ferede G, Gelaw B. Prevalence, antibiotic susceptibility profile and associated factors of group a streptococcal pharyngitis among pediatric patients with acute pharyngitis in Gondar, Northwest Ethiopia. Infect Drug Resist 2023;16:1637-48. doi: 10.2147/IDR.S402292.
42. Societŕ Italiana di Pediatria. Streptococco, dai test rapidi agli antibiotici, dalle allergie al rientro a scuola: ecco la guida della SIP. 24 maggio 2023.
43. AIFA. Manuale antibiotici AWaRe (Access, Watch, Reserve). Edizione italiana del “The WHO AWaRe Antibiotic Book”. Gennaio 2023.
44. Di Mario S, Gagliotti C, Moro ML, a nome del Gruppo ProBA. La faringotonsillite in etŕ pediatrica; Aggiornamento delle linee guida della Regione Emilia-Romagna. Medico e Bambino 2015;34(7):442-7.
45. van Driel ML, De Sutter AI, Thorning S, Christiaens T. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database Syst Rev 2021;3(3):CD004406. doi: 10.1002/14651858.CD004406.
46. Leone V, Panizon F. Streptococco: tra il dire e il fare, ovvero sulla conflittualitŕ tra le raccomandazioni ufficiali e la pratica clinica. Medico e Bambino 2002;21(6):377-82.
47. Marchetti F, Barbi E. Antibiotici. Medico e Bambino 2021;40(26):2. doi: 10.53126/ MEB40S701.
48. Tommasini A, Lepore L. Le sindromi autoinfiammatorie: quando non č solo PFAPA. Medico e Bambino 2021;40(4):221-5. doi: 10.53126/MEB40221.
49. van der Putten BCL, Bril-Keijzers WCM, et al. Novel emm4 lineage associated with an upsurge in invasive group A streptococcal disease in the Netherlands, 2022. Microb Genom 2023;9(6). doi: 10.1099/mgen.0.001026.
50. Ferretti JJ, Stevens DL, Fischetti VA (eds). Streptococcus pyogenes: Basic Biology to Clinical Manifestations [Internet]. 2nd ed. Oklahoma City (OK): University of Oklahoma Health Sciences Center 2022 Oct 8.
51. Martin JM. The mysteries of streptococcal pharyngitis. Curr Treat Options Pediatr 2015; 1(2):180-9. doi: 10.1007/s40746-015-0013-9.
52. Marchetti F. Amoxicillina: quando manca l’essenziale. Medico e Bambino 2023;42(4): 255-257. doi: 10.53126/MEB42255.
Corrispondenza: alessandra.iacono@auslromagna.it