Use of the McIsaac Score to Predict Group A Streptococcal Pharyngitis in Outpatient Nurse Phone Triage and Electronic Visits Compared With In-Person Visits: Retrospective Observational Study

Background The McIsaac criteria are a validated scoring system used to determine the likelihood of an acute sore throat being caused by group A streptococcus (GAS) to stratify patients who need strep testing. Objective We aim to compare McIsaac criteria obtained during face-to-face (f2f) and non-f2f encounters. Methods This retrospective study compared the percentage of positive GAS tests by McIsaac score for scores calculated during nurse protocol phone encounters, e-visits (electronic visits), and in person f2f clinic visits. Results There was no difference in percentages of positive strep tests between encounter types for any of the McIsaac scores. There were significantly more phone and e-visit encounters with any missing score components compared with f2f visits. For individual score components, there were significantly fewer e-visits missing fever and cough information compared with phone encounters and f2f encounters. F2f encounters were significantly less likely to be missing descriptions of tonsils and lymphadenopathy compared with phone and e-visit encounters. McIsaac scores of 4 had positive GAS rates of 55% to 68% across encounter types. There were 4 encounters not missing any score components with a McIsaac score of 0. None of these 4 encounters had a positive GAS test. Conclusions McIsaac scores of 4 collected during non-f2f care could be used to consider empiric treatment for GAS without testing if significant barriers to testing exist such as the COVID-19 pandemic or geographic barriers. Future studies should evaluate further whether non-f2f encounters with McIsaac scores of 0 can be safely excluded from GAS testing.

The First Six Registered Pediatric Cases with COIVID-19 in Libya: A Case Study

Globally, fewer cases of COVID-19 have been reported in children (age 0-17 years) compared with adults [1,2], The number and rate of cases in children have been steadily increasing since March 2020. The true incidence of SARS-CoV-2 infection in children is not known due to lack of widespread testing and the prioritization of testing for adults and those with severe illness. Hospitalization rates in children are significantly lower than hospitalization rates in adults with COVID-19, suggesting that children may have less severe illness from COVID-19 compared to adults [5,6]. Evidence suggests that compared to adults, children likely have similar viral loads in their nasopharynx, [7] similar secondary infections rates, and can spread the virus to others [8,9]. Due to community mitigation measures and school closures, transmission of SARS-CoV-2 to and among children may have been reduced during the pandemic in the spring and early summer of 2020. This may explain the low incidence in children compared with adults. Comparing trends in pediatric infections before and after the return to child care, in-person school, youth sports and other activities may enhance our understanding about infections in children. Children infected with SARS-CoV-2 may have many of these non-specific symptoms, only have a few (such as only upper respiratory symptoms or only gastrointestinal symptoms), or may be asymptomatic. The most common symptoms in children are cough and/or fever [11-15]. A recent systematic review estimated that 16% of children with SARS-CoV-2 infection are asymptomatic, [16] but evidence suggests that as many as half of pediatric infections may be asymptomatic [17] The signs and symptoms of COVID-19 in children are similar to those of other infections and noninfectious processes, including influenza, streptococcal pharyngitis, and allergic rhinitis. The lack of specificity of signs or symptoms and the significant proportion of asymptomatic infections make symptom-based screening for identification of SARS-CoV-2 in children particularly challenging [17].

DEVELOPMENT OF CIPROFLOXACIN LOADED THROAT PAINT FOR THE TREATMENT OF STREP THROAT INFECTION

Objective: This study is to enhance the solubility and sustained release of ciprofloxacin (CPX) drug by amplifying the adhesive capability of formulation by forming throat paint for the Streptococcal pharyngitis, a sore throat infection. Methods: Solid dispersion was prepared by solvent evaporation technique, in which three different ratios of Polyethylene glycol-6000 (PEG-6000) were selected, and the best ratio of solid dispersion was selected after characterization including Scanning electron microscopy (SEM) and Differential scanning calorimetry (DSC) with evaluation parameters including % yield, drug content, and drug solubility. In the case of throat paint, out of six different formulations, the best formulation was selected through viscosity, in vitro mucoadhesion, in situ release study, and spreadability parameters. Results: The DSC and SEM data proved that solid dispersion has a different moiety than its ingredients but it is quite a stable form. Formulation MD-2 was selected as the best formulation which able to increase the solubility of the drug by more than 3.5 folds, at the same time it shows the highest rate of drug dissolution of 13.951 μg/ml with % yield (97.199±0.167%) and drug content (96.425%). Throat paint was formed by fusion and trituration process and out of all six formulations F3 was selected as the best formulation on the basis of Viscosity (11932 Centi poise), Spreadability (17.621), Mucoadhesion (3937.481 dyne/cm2), and drug release (90.336±0.6%). Conclusion: Solid dispersion was successfully prepared with 3.5 times of solubility enhancement capability in comparison with pure CPX drug. The throat paint releases the drug (≥3 h) in a sustained manner with high mucoadhesive force.

Differential diagnosis and effective therapy for sore throat

Sore throat is a common complaint, which can be caused by a typical viral pharyngitis, or it can be rooted in a life-threatening disease such as epiglottitis or inflammation of the cellular spaces in the throat and neck. The doctor should take a closer look at a patient with a sore throat, immediately make a differential diagnosis and prescribe adequate treatment, including surgical intervention, if necessary.The article discusses the most common causes of a sore throat, including various types of pharyngitis, paratonsillar abscess, parapharyngeal abscess, retropharyngeal abscess, epiglottitis.Viral pharyngitis has a favourable prognosis, resolves without intervention and complications, but bacterial and fungal pharyngitis have a more severe course. Streptococcal pharyngitis caused by group A в-hemolytic streptococcus holds a dominant position in bacterial etiology and requires the use of antibiotic therapy. The differential diagnosis of streptococcal pharyngitis is based on the modified Centor scores in the routine clinical practice. Antibiotic therapy for streptococcal pharyngitis includes a 10-day course of unprotected penicillins. If a patient has an allergic reaction to penicillins, it is recommended to use clindamycin or clarithromycin. The surgical intervention combined with intramuscular or intravenous antibiotic therapy is recommended for the treatment of purulent processes in the cellular spaces of the neck. These diseases can have life-threatening complications, which include neurological damage, the spread of purulent process in the mediastinum with the development of mediastinitis, laryn-geal stenosis, sepsis, necrotizing fasciitis, jugular vein thrombosis and erosion of the carotid artery. The third generation cephalosporins and protected penicillins are recommended for the treatment of epiglottitis, and respiratory fluoroquinolones are used, if a patient has a history of allergic reactions to penicillins. In severe cases with symptoms of stenosis, intubation can be performed in addition to the use of antibiotics.

Age and sex-specific incidence rates of group A streptococcal pharyngitis between 2010 and 2018: a population-based study

Aim: Group A streptococcus (GAS) pharyngitis is a common clinical infection with significant morbidity but remains understudied. Materials & methods: We sought to assess the rates of testing and incidence of GAS pharyngitis in Calgary, Alberta based on age and sex. Results: A total of 1,074,154 tests were analyzed (58.8% female, mean age 24.8 years) of which 16.6% were positive. Age-standardized testing and positivity was greatest in the 5–14 years age group and lowest in persons over 75 years. Females had greater rates of testing and positivity throughout. Testing rates (incidence rate ratios: 1.40, 95% CI: 1.39–1.41) and case rates (incidence rate ratios: 1.36, 95% CI: 1.33–1.39) increased over time. Conclusion: Future studies should focus on evaluating disparities in testing and treatment outcomes to optimize the approach to this infection.

Single-centre, open-label, randomised, trial to compare rapid molecular point-of-care streptococcal testing to standard laboratory-based testing for the management of streptococcal pharyngitis in children: study protocol

IntroductionStreptococcal pharyngitis, which commonly occurs in children, should be treated with antibiotics. Clinical prediction rules to differentiate streptococcal pharyngitis from viral infection are not recommended in children. Rapid point-of-care (POC) antigen tests have limited sensitivity and so are not often used in Canadian paediatric emergency departments (EDs). Standard paediatric practice is to rely on laboratory-based testing, which often results in a delay before the results can be communicated to the patient; this may impede appropriate prescribing, decrease caregiver satisfaction and delay recovery. The objective of this study is to determine whether a novel rapid molecular POC assay for streptococcal pharyngitis leads to more appropriate antibiotic use in children seeking care in a paediatric ED than standard laboratory-based testing.Methods and analysisA randomised, superiority, open-label, trial with two parallel groups. Children presenting to a tertiary paediatric ED at least 3 years of age who have a throat swab ordered for diagnosis of streptococcal pharyngitis will be eligible; those who have taken antibiotics within 72 hours prior to presentation and those with additional active infections will be excluded. The primary study outcome will be appropriate antibiotic treatment at 3–5 days postenrolment. Secondary outcomes include time to symptom resolution, caregiver satisfaction, caregiver/child absenteeism, number of subsequent healthcare visits, clinician satisfaction and incremental cost-effectiveness of POC testing. A total of 352 participants will be needed.Ethics and disseminationAll study documentation has been approved by the Hamilton Integrated Research Ethics board and informed consent will be obtained from all participants. Data from this trial will be presented at major conferences and published in peer-reviewed publications to facilitate collaborations with networks of clinicians experienced in the dissemination of clinical guidelines.Trial registration numberNCT04247243.