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Non-group A strep: A continuing debate
The Clinical Advisor, 06/25/09

Spak CW - The morbidity associated with common pharyngitis is minimal; therefore it is reasonable to withhold treatment if associated clinical factors support that a particular case is not due to group A streptococcal infection (GAS). In confirmed cases of non-group A streptococcal disease, however, suppurative complications, though rare, have been known to occur, including otitis media, acute sinusitis, and quinsy. In one recent review, for example, 14 of 58 cases of peritonsillar abscess requiring hospitalization were due to non-GAS. The real controversy stems from the lack of clear data, hence the equipoise for this important question. Cochrane Review evaluated all cases (only 2,835) of pharyngitis (GAS as well as all other causes) in the published literature from 27 studies across the world. The most important conclusions drawn from these limited data were that (1) the incidence of rheumatic fever was vanishingly small in developed countries such as the United States, but (2) the use of antibiotics was associated with a reduction of up to 85% in local suppurative complications. The clinician needs to weigh such issues of uncertainty in decisions to treat - and then determine what steps are appropriate for the patient who presents with a sore throat.

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