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Strep A: Are we creating a bigger problem with a short-sighted solution?

Will the increased use in antibiotics for strep A undo all our hard work on antimicrobial resistance? Nana Ofori-Atta fears so

Antimicrobial resistance has been a big issue within the healthcare community. For years now we have been told that the overuse of antimicrobials is a global challenge, that has contributed to antimicrobial resistance and increased mortality rates. The advice has always been to try to use fewer antibiotics when possible.

The government’s Tackling antimicrobial resistance 2019–2024: UK’s five year national action plan – published in 2019 – set out a number of ambitions, which included:

  • halving healthcare-associated gram-negative bloodstream infections
  • reducing the number of specific drug-resistant infections by 10% by 2025
  • reducing UK antimicrobial use among humans by 15% by 2024
  • being able to report on the percentage of prescriptions supported by a diagnostic test or decision support tool by 2024.

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

It is very difficult to see how we will be reaching these ambitions if the whole healthcare system is now being encouraged to use antibiotics as first-line treatment in children presenting with any symptoms of infections.

This action in turn is leading to a sudden demand in antibiotics and therefore a shortage of antibiotics within the pharmacy sector.

The actions taken by healthcare leaders shows a clear hypocrisy within the messaging we are sending to the public.

The increased threat of strep A within the community has led to patient anxiety when it comes to infections and flu-like symptoms and the response from healthcare instead of being to calm patient anxiety and reassure them has been to take an antibiotics-for-all approach instead.

This could be attributed to the pressures within GP surgeries, combined with pressures on secondary care and the increased anxieties among patients because of the media representation of strep A conditions.

Read more: Strep A: Children can take oral solid form antibiotics amid demand surge

Do we risk creating a bigger problem in the future, where children no longer respond to antibiotic treatments and infections develop resistance to our current treatments?

As pharmacists we are antibiotic stewards and therefore should be committed to reducing the unnecessary use of antibiotics in patients to reduce the chances of disease-causing bacteria becoming resistant to our existing antibiotic treatments.

As there are no new antibiotics hitting the market anytime soon, the risk of bacteria developing resistance to our existing antibiotics is a real danger and a risk we must keep working to avoid.

For years we have been confusing flu-like symptoms, usually caused by a virus, with antibiotic treatments only suitable for bacterial infections.

It is easy to do as most presenting symptoms do resemble each other and, in most cases, the only way to distinguish is to test for the exact pathogen causing the symptoms.

This does beg the bigger question of what we should be doing instead of relying so heavily on antibiotics. The solution lies in diagnosis.

We should aim to correctly identify the specific bacteria causing the infections instead of just using broad spectrum antibiotics at the first sign of a symptom.

Pharmacy teams are well placed to perform throat swabs to test for infections to verify the presence of an infection which requires antibiotic treatment.

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

Nana Ofori-Atta is clinical and custom content editor at C+D

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