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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
- Emma McGuire1 , Ang Li1 , Simon M Collin1 , Valerie Decraene1 , Michael Cook1 , Simon Padfield1 , Shiranee Sriskandan2 , Chris Van Beneden3 , Theresa Lamagni1 , Colin S Brown1,2
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View Affiliations Hide AffiliationsAffiliations: 1 United Kingdom Health Security Agency (UKHSA), London, United Kingdom 2 NIHR Health Protection Research Unit in Healthcare-associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Hospital Campus, London, United Kingdom 3 CDC Foundation, Atlanta, Georgia, United States
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Citation style for this article: McGuire Emma, Li Ang, Collin Simon M, Decraene Valerie, Cook Michael, Padfield Simon, Sriskandan Shiranee, Van Beneden Chris, Lamagni Theresa, Brown Colin 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):pii=2200573. https://doi.org/10.2807/1560-7917.ES.2023.28.15.2200573 Received: 13 Jul 2022; Accepted: 10 Feb 2023
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Abstract
Public health guidance recommending isolation of individuals with group A streptococcal (GAS) infection or carriage for 12–24 h from antibiotic initiation to prevent onward transmission requires a strong evidence base.
To estimate the pooled proportion of individuals who remain GAS culture-positive at set intervals after initiation of antibiotics through a systematic literature review (PROSPERO CRD42021290364) and meta-analysis.
We searched Ovid MEDLINE (1946–), EMBASE (1974–) and Cochrane library. We included interventional or observational studies with ≥ 10 participants reporting rates of GAS throat culture positivity during antibiotic treatment for culture-confirmed GAS pharyngitis, scarlet fever and asymptomatic pharyngeal GAS carriage. We did not apply age, language or geographical restrictions.
Of 5,058 unique records, 43 were included (37 randomised controlled studies, three non-randomised controlled trials and three before-and-after studies). The proportion of individuals remaining culture-positive on day 1, day 2 and days 3–9 were 6.9% (95% CI: 2.7–16.8%), 5.4% (95% CI: 2.1–13.3%) and 2.6% (95% CI: 1.6–4.2%). For penicillins and cephalosporins, day 1 positivity was 6.5% (95% CI: 2.5–16.1%) and 1.6% (95% CI: 0.04–42.9%), respectively. Overall, for 9.1% (95% CI: 7.3–11.3), throat swabs collected after completion of therapy were GAS culture-positive. Only six studies had low risk of bias.
Our review provides evidence that antibiotics for pharyngeal GAS achieve a high rate of culture conversion within 24 h but highlights the need for further research given methodological limitations of published studies and imprecision of pooled estimates. Further evidence is needed for non-beta-lactam antibiotics and asymptomatic individuals.
This work is licensed under a Creative Commons Attribution 4.0 International License.
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