image of Prevalence and Susceptibility Profiles of Group A Streptococcus in Primary Care Patients with a Sore Throat and Fever in Thailand and the Utility of C-Reactive Protein and Clinical Scores for Its Identification
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Pharyngitis is usually caused by a viral infection for which antibiotics are often unnecessarily prescribed, adding to the burden of antimicrobial resistance. Identifying who needs antibiotics is challenging; microbiological confirmation and clinical scores are used but have limitations. In a cross-sectional study nested within a randomized controlled trial, we estimated the prevalence and antibiotic susceptibility profiles of group A (GAS) in patients presenting to primary care with a sore throat and fever in Northern Thailand. We then evaluated the use of C-reactive protein (CRP) and clinical scores (Centor and FeverPAIN) to identify the presence of GAS. One hundred sixty-nine patients were enrolled, of whom 35 (20.7%) had β-hemolytic (BHS) isolated from throat swab culture, and 11 (6.5%) had GAS. All GAS isolates were sensitive to penicillin G. The median CRP of those without BHS isolation was 10 mg/L (IQR ≤ 8–18), compared with 18 mg/L (IQR 9–71, = 0.0302) for those with GAS and 14 mg/L (IQR ≤ 8–38, = 0.0516) for those with any BHS isolated. However, there were no significant relationships between CRP > 8 mg/L ( = 0.112), Centor ≥ 3 ( = 0.212), and FeverPAIN ≥ 4 ( = 1.000), and the diagnosis of GAS compared with no BHS isolation. Identifying who requires antibiotics for pharyngitis remains challenging and necessitates further larger studies. C-reactive protein testing alone, although imperfect, can reduce prescribing compared with routine care. Targeted CRP testing through clinical scoring may be the most cost-effective approach to ruling out GAS infection.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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  • Received : 02 Jul 2019
  • Accepted : 11 Nov 2019
  • Published online : 30 Dec 2019
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