To support GPs through the current national Strep A outbreaks, the following information is available:
NHS Specialist Pharmacy Services guidance for using solid oral dosage form antibiotics in children aged one year and over: Using solid oral dosage form antibiotics in children – SPS – Specialist Pharmacy Service – The first stop for professional medicines advice
Solid dose forms can be used to provide doses for children of 1 year and above, so liquid formulations should be reserved for children under 1 year wherever possible. NICE guidance for sore throat offers a penicillin V dosing regimen of 250mg TWICE daily for children of 1 year and above and amoxicillin at 250mg three times a day for children of 1 year and above.
Early indications are that stocks are available at manufacturers and will be shipped to wholesalers urgently with some co-ordination to reduce stock piling and ensure equity of distribution.
Recommendations for primary care:
- Given the unusually high level of GAS, and viral co-circulation in the community, health care professionals are asked to have a low threshold to consider and empirically prescribe antibiotics to children presenting with features of GAS infection, including where secondary to viral respiratory illness.
- Consider taking a throat swab to assist with differential diagnosis or if the patient is thought to be part of an outbreak (to confirm aetiology), allergic to penicillin (to determine antimicrobial susceptibility) or in regular contact with vulnerable individuals
- Parents of children with presumed respiratory viral infection should be made aware of features suggestive of secondary bacterial infection, such as clinical deterioration, and when and how to seek further help. Safety netting advice for parents can be found on the link below.
- GPs should maintain a low threshold for prompt referral to secondary care of any children presenting with persistent or worsening symptoms.