Skip to main content

Advertisement

SpringerLink
Log in

Pediatrician’s approach to diagnosis and management of group A streptococcal pharyngitis

  • Original Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Group A streptococcal (GAS) pharyngitis is responsible for 20–30% of pharyngitis cases in children (Shulman et al. Clin Infect Dis 55(10):e86–e102, 2012). Recommendations for the diagnosis and treatment of GAS pharyngitis have been published by the Italian National Institute of Health guidelines in 2012 (ESCMID Sore Throat Guideline Group et al. Clin Microbiol Infect 18(Suppl 1):1–28, 2012). Adherence to such guidance is relevant for primary prevention of complications of GAS pharyngitis, above all rheumatic fever (RF). The aim of our study was to evaluate the application of Italian guidelines by the family pediatricians from the Abruzzo region. A validated questionnaire was completed by the family pediatricians and used for data collection. The 154 family pediatricians from Abruzzo (88% of the total number of family pediatricians) participated in the study. Out of the 1232 answers, 455 (37%) were wrong. Only 8% of the participants answered correctly all the questions, whereas 0.6% missed all the questions. Through the Spearman’s correlation, our study found an inverse significant correlation between the questions regarding primary prophylaxis (Score B) and the work experience of pediatricians (Rho = − 0.276, p = 0.048). The majority of the family pediatricians from the Abruzzo region, in line with studies from other countries, have significant knowledge gaps about the diagnosis and treatment of GAS pharyngitis. Therefore, strategies to increase the pediatricians’ awareness of the guidelines are needed, in order to reduce the RF incidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

GAS:

Group A streptococcus

IDSA:

Infectious Disease Society of America

IG:

Italian guidelines

LHU:

Local Health Unit

RADT:

Rapid antigen detection test

RF:

Rheumatic fever

SPSS:

Statistical Package for the Social Sciences

References

  1. Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, Martin JM, Van Beneden C (2012) Clinical practice guideline for the diagnosis and Management of Group a Streptococcal Pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 55(10):e86–e102

    Article  Google Scholar 

  2. ESCMID Sore Throat Guideline Group, Pelucchi C, Grigoryan L, Galeone C, Esposito S, Huovinen P, Little P, Verheij T. Guideline for the management of acute sore throat. Clin Microbiol Infect. 2012 Apr;18 Suppl 1:1–28

  3. Chiappini E, Principi N, Mansi N et al (2012) Italian panel management of acute pharyngitis in children: summary of the Italian National Institute of health guidelines. Clin Ther 34:1442–1458

    Article  CAS  Google Scholar 

  4. Breda L, Marzetti V, Gaspari S, Del Torto M, Chiarelli F, Altobelli E (2012) Population-based study of incidence and clinical characteristics of rheumatic fever in Abruzzo, Central Italy, 2000-2009. J Pediatr 160:832–836

    Article  Google Scholar 

  5. Pastore S, De Cunto A, Benettoni A, Berton E, Taddio A, Lepore L (2011) The resurgence of rheumatic fever in a developed country area: the role of echocardiography. Rheumatology 50:396–400

    Article  Google Scholar 

  6. Hedin K, Strandberg EL, Gröndal H, Brorsson A, Thulesius H, André M (2014 Dec) Management of patients with sore throats in relation to guidelines: an interview study in Sweden. Scand J Prim Health Care 32(4):193–199

    Article  Google Scholar 

  7. Alkhazi AA, Alessa KM, Almutairi AM, Almadi HA, Akkam A, Almutairi MK, Alhamad OA, Ghazal HS (2018 Nov 16) Improving pediatric emergency department physicians' adherence to clinical practice guidelines on the diagnosis and management of group a betahemolytic streptococcal pharyngitis-a cross-sectional study. Int J Emerg Med 11:49

    Article  Google Scholar 

  8. Brennan-Krohn T, Ozonoff A, Sandora TJ (2018 Feb 9) Adherence to guidelines for testing and treatment of children with pharyngitis: a retrospective study. BMC Pediatr 18(1):43

    Article  Google Scholar 

  9. Norton LE, Lee BR, Harte L, Mann K, Newland JG, Grimes RA, Myers AL. Improving guideline-based streptococcal pharyngitis testing: a quality improvement initiative. Pediatrics. 2018 Jul;142(1). pii: e20172033

  10. Milne RJ, Lennon DR, Stewart JM, Vander Hoorn S, Scuffham PA (2012) Incidence of acute rheumatic fever in New Zealand children and youth. J Paediatr Child Health 48:685–691

    Article  Google Scholar 

  11. Lawrence JG, Carapetis JR, Griffiths K, Edwards K, Condon JR (2013) Acute rheumatic fever and rheumatic heart disease: incidence and progression in the Northern Territory of Australia, 1997 to 2010. Circulation 128:492–501

    Article  Google Scholar 

  12. Karthikeyan G, Guilherme L (2018) Acute rheumatic fever. Lancet 392:161–174

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Chieti-Pescara, Chieti, Italy

    Ilenia Di Muzio, Debora Mariarita d’Angelo, Caterina Di Battista, Giuseppe Lapergola & Luciana Breda

  2. Department of Life, Health and Environmental Sciences, Epidemiology Unit, University of Aquila, L’Aquila, Italy

    Ilaria Zenobi & Emma Altobelli

  3. Department of Pediatrics, Civitanova Marche Hospital, Civitanova Marche, Italy

    Valentina Marzetti

Authors
  1. Ilenia Di Muzio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Debora Mariarita d’Angelo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Caterina Di Battista
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giuseppe Lapergola
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ilaria Zenobi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Valentina Marzetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luciana Breda
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Emma Altobelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DM I: Collected the data.

d’ADM: Wrote the paper.

DB C: Wrote the paper.

L G: Collected the data.

Z I: Performed the analysis.

B L: Conceived and designed the analysis.

AE: Contributed data or analysis tools.

Corresponding author

Correspondence to Luciana Breda.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all the individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

What is known:

• Adherence to recommendations for the management of GAS pharyngitis is relevant for an effective primary prevention of rheumatic fever (RF).

• In recent years, a resurgence of RF has been documented also in developed countries.

What is new:

• The majority of the family pediatricians from the Abruzzo region in Italy, in line with other countries, have significant knowledge gaps about the adherence to pharyngitis guidelines.

• Repeated information among the family pediatricians is needed in order to prevent rheumatic heart disease.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Di Muzio, I., d’Angelo, D.M., Di Battista, C. et al. Pediatrician’s approach to diagnosis and management of group A streptococcal pharyngitis. Eur J Clin Microbiol Infect Dis 39, 1103–1107 (2020). https://doi.org/10.1007/s10096-020-03821-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-020-03821-y

Keywords

Search

Navigation