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Abstract

Background

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.

Aim

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.

Methods

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.

Results

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.

Conclusions

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.

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A corrected article has been published for this content:
Erratum for Euro Surveill. 2023;28(15)
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2023-04-13
2024-04-27
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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
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Emma+McGuire&option1=author&noRedirect=true" class="nonDisambigAuthorLink">McGuire Emma</a>, <a href="/search?value1=Ang+Li&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Li Ang</a>, <a href="/search?value1=Simon+M+Collin&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Collin Simon M</a>, <a href="/search?value1=Valerie+Decraene&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Decraene Valerie</a>, <a href="/search?value1=Michael+Cook&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cook Michael</a>, <a href="/search?value1=Simon+Padfield&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Padfield Simon</a>, <a href="/search?value1=Shiranee+Sriskandan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sriskandan Shiranee</a>, <a href="/search?value1=Chris+Van+Beneden&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Van Beneden Chris</a>, <a href="/search?value1=Theresa+Lamagni&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lamagni Theresa</a>, <a href="/search?value1=Colin+S+Brown&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Brown Colin S</a></span>. 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. <a href="/content/ecdc">Euro Surveill.</a> 2023;28(15):pii=2200573. <a href="https://doi.org/10.2807/1560-7917.ES.2023.28.15.2200573" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2023.28.15.2200573</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 13 Jul 2022;&nbsp;&nbsp; <span class="generated">Accepted</span>: 10 Feb 2023 </span> </p>
/content/10.2807/1560-7917.ES.2023.28.15.2200573
/content/10.2807/1560-7917.ES.2023.28.15.2200573
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