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Strep A: A frontline perspective from a community pharmacist

We have heard a lot about the antibiotic scrambles and struggles endured by pharmacists as unusual numbers of strep A cases present themselves. But what of the wider response? Anna Matthews gives her account from the frontline in south Wales

Following recent reports detailing a higher number of deaths than usual resulting from invasive group A streptococcus (iGAS), I think the whole of primary care is experiencing a surge in queries around strep A.

It’s winter, and there are several circulating viruses that present similarly to strep infections, which can make diagnosis trickier.

Prescribers have been advised to practice with a lower antibiotic threshold, which seems in contrast to the usual caution over antimicrobial resistance (AMR). But early antibiotic prescribing should help to reduce the risk of iGAS, which is the more pressing concern.

The Sore Throat Test and Treat (STTT) service provided by many pharmacies in Wales, although not available for those with symptoms of scarlet fever or children under six, is beneficial for those with symptoms of tonsillitis. The service offers advice, referral, or treatment with antibiotics if required following a positive strep A point-of-care test.


Read more: Strep A and scarlet fever: What pharmacists should know and advise

This can help reduce concerns over AMR as only those with confirmed bacterial infection are offered antibiotics.

Pharmacies have seen a massive increase in demand for the service, coupled with difficulty in obtaining antibiotics: many oral solution formulations such as phenoxymethylpenicillin, clarithromycin and amoxicillin are unavailable – and we’re seeing increased costs for other formulations, too.

No pharmacy wants to send patients away without antibiotics, and patients are panicked and frustrated.

Rapid spread of misinformation from non-healthcare sources via social media means that initially we’ve had requests for throat swabs to 'screen' for strep A for young children or patients without symptoms, which are not within the service specification – and faced with a scared parent, this can be difficult to manage.

These added pressures and increases in service demand pose a challenge for pharmacy teams doing their utmost to provide a good service during an already busy period.

Read more: Strep A: Pharmacists warn of amoxicillin shortages as infections rocket

As a community pharmacist working in Cwm Taf Morgannwg University Health Board in Wales, I am amazed by the effort shown by primary care in response to the situation.
Everyone I’ve seen is working incredibly hard to provide the best possible care.

The relationships formed within our Rhondda Primary Care Cluster have allowed pharmacies and GP colleagues to share up-to-date information on stock availability and treatment options.
The Welsh government, Community Pharmacy Wales (CPW) and local health boards (LHBs) have responded rapidly, combating misinformation on social media and promoting appropriate STTT utilisation.

They have provided guidance on diagnosing, signposting and treating in strep A infections.
They have also provided guidance on the stability of crushing/dispersing tablets for use in children in the absence of available oral solution formulations.

Out-of-hours services and clinical support hubs across Wales have circulated contact numbers for queries regarding prescriptions, stock and service availability and Public Health Wales has issued interim guidance for managing GAS and scarlet fever in children.

Overall, the response has been quick, thorough and immeasurably useful.


Read more: Strep A: No antibiotics shortage, just ‘huge’ surge in demand, say wholesalers

Without this support, the story would undoubtedly be different.

I’m constantly blown away by the efforts shown by pharmacy teams in a job that often faces issues that are out of our control.

This could have been a tale of stress and exhaustion – it is difficult to keep all the plates spinning. But I see it as yet another challenge faced by community pharmacy where the hard work of pharmacy teams, plus quick intervention and guidance from LHBs, PHW, CPW and the Welsh government has helped to find solutions and provide the best care we can to our patients.

Anna Matthews is pharmacy manager at Avicenna Pharmacy in south Wales


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