1. Are RADTs(rapid antigen detection tests) alone adequate for the diagnosis of GAS(group A streptococcus) pharyngitis?
No, only if they are positive. A negative RADT result should be confirmed by the more sensitive culture.
2. How many days after onset of GAS pharyngitis will therapy be effective in preventing ARF?
Therapy started as late as 9 days after illness onset has been shown to be effective in preventing ARF.
3. Is there any benefit to starting therapy while waiting for culture results?
Immediate therapy probably shortens the symptomatic period, but
waiting for a positive test result avoids overuse of antibiotics.
4. Does an asymptomatic patient with a positive test for GAS from the pharynx (e.g., a chronic carrier) require therapy?
Usually not. Between 8% and 20% of children in school or day care will have asymptomatic carriage of GAS and generally do not require therapy. Exceptions are those with a history of ARF, outbreak situations, or to achieve eradication in families with recurrent episodes of GAS pharyngitis.
5. Is there any evidence of GAS resistance to penicillin and other β-lactam antibiotics?
No, GAS has never been found to be resistant to penicillin, but some studies suggest tolerance to penicillin where penicillin is bacteriostatic rather than bactericidal. However, 2–8% of GAS strains will be resistant to macrolides.
6. Is tonsillectomy indicated for recurrent GAS pharyngitis?
Rare patients in whom multiple symptomatic episodes of laboratory-confirmed GAS pharyngitis occur despite appropriate therapy may be considered for tonsillectomy.
7. Is continuous antimicrobial prophylaxis for recurrent GAS pharyngitis recommended?
No, there is insufficient evidence to show that it is effective, except for preventing recurrences of ARF.
(Modified from 5-Minute Pediatric Consult book)