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In Kids with Group A Strep, Do Steroids Shorten Illness Duration, Severity?

By and | on November 18, 2020 | 1 Comment
Kids korner
shut by Landon Jones, MD, and Richard M. Cantor, MD, FAAP, FACEP The best questions often stem from the inquisitive learner. As educators, we love, and are always humbled by, those moments when we get to say, “I don’t know.” For some of these questions, you may already know the answers. For others, you may never have thought to ask the question. For all, questions, comments, concerns, and critiques are encouraged. Welcome to the Kids Korner. Antibiotics for Strep Question 1: In children with group A strep pharyngitis, what benefit(s) does antibiotic treatment offer? While a potentially reasonable argument may be made about deferring antibiotic treatment of GAS-positive pharyngitis, is antibiotic treatment beneficial? To begin, an earlier RCT by Nelson evaluated 35 children ages 5–11 years with GAS confirmed by culture and randomized patients to penicillin (PCN) treatment or placebo.1 Follow-up visits occurred at 48 hours. Patients treated with PCN had a significantly shorter duration of fever at follow-up, with 28 percent of placebo patients having persistent fever >48 hours but no treated patients having persistent fever (P=0.031). At 48-hour follow-up, children receiving PCN also had significantly shortened times until improved (P=0.008) and until well (P=0.022). A similar shortened duration of fever at 48 hours was seen in another RCT by Pichichero et al.2 A Cochrane meta-analysis by Spinks et al evaluated 27 trials with 12,835 total cases.3 This included both adults and children and included patients with the diagnosis of sore throat, not specifically GAS. Regarding antibiotics versus placebo, the risk ratio of the incidence of developing the secondary complication of otitis media within 14 days following GAS pharyngitis antibiotic treatment was 0.30 (95 percent CI, 0.15–0.58; 11 studies), suggesting that antibiotic therapy decreased the incidence of the complication of otitis media. Similarly, the risk ratio of the incidence of developing “quinsy”—meaning peritonsillar abscess or retropharyngeal abscess—within two months following GAS antibiotic treatment was 0.15 (95 percent CI, 0.05–0.47; eight studies). Lastly, the risk ratio of the incidence of developing acute rheumatic fever (ARF) within two months was 0.27 (95 percent CI, 0.1–0.50; 14 studies). While ARF is traditionally rare in Western countries (

Conclusion

In children who are group A strep positive by rapid strep test, a single dose of oral dexamethasone 0.6 mg/kg (maximum of 10 mg) appears to shorten initial onset of pain relief by approximately six hours. It does not appear to shorten the time to complete relief of pain.

References

  1. O’Brien JF, Meade JL, Falk JL. Dexamethasone as adjuvant therapy for severe acute pharyngitis. Ann Emerg Med. 1993; 22(2):212-215.
  2. Wei JL, Kasperbauer JL, Weaver AL, et al. Efficacy of single-dose dexamethasone as adjuvant therapy for acute pharyngitis. Laryngoscope. 2002;112(1):87-93.
  3. Bulloch B, Kabani A, Tenenbein M. Oral dexamethasone for the treatment of pain in children with acute pharyngitis: a randomized, double-blind, placebo-controlled trial. Ann Emerg Med. 2003;41(5):601-608.
  4. Olympia RP, Khine H, Avner JR. Effectiveness of oral dexamethasone in the treatment of moderate to severe pharyngitis in children. Arch Pediatr Adolesc Med. 2005;159(3):278-282.
  5. Niland M, Bonsu BK, Nuss KE, et al. A pilot study of 1 versus 3 days of dexamethasone as add-on therapy in children with streptococcal pharyngitis. Pediatr Infect Dis J. 2006;25(6):477-481.
  6. Wing A, Villa-Roel C, Yeh B, et al. Effectiveness of corticosteroid treatment in acute pharyngitis: a systematic review of the literature. Acad Emerg Med. 2010;17(5):476-483.
  7. Schams SC, Goldman RD. Steroids as adjuvant treatment of sore throat in acute bacterial pharyngitis. Can Fam Physician. 2012;58(1):52-54.
  8. Chiappini E, Bortone B, Di Mauro G, et al. Choosing wisely: the top-5 recommendations from the Italian panel of the national guidelines for the management of acute pharyngitis in children. Clin Ther. 2017;39(3):646-649.

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About the Authors

Landon Jones, MD

Dr. Jones is associate professor and pediatric emergency medicine fellowship director at the University of Kentucky Department of Emergency Medicine & Pediatrics in Lexington, Kentucky.

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Richard M. Cantor, MD, FAAP, FACEP

Dr. Cantor is professor of emergency medicine and pediatrics, director of the pediatric emergency department, and medical director of the Central New York Regional Poison Control Center at Upstate Medical University in Syracuse, New York.

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One Response to “In Kids with Group A Strep, Do Steroids Shorten Illness Duration, Severity?”

  1. December 13, 2020

    gopala k derebail Reply

    Has there been any study conducted to determine the consequence of GAS, i.e. rheumatic fever and other rheumatic sequale in the two groups?

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