Dear Colleagues
This is enquiry to see whether anyone is doing this research. If not then maybe we should
There is a group in Canada who uses an open source electronic medical record called OSCAR
I was asking that the rewrite of the prescribing module allowed us to tag prescriptions as "delayed" when we advice patients to wait a few days.
Out of this came a discussion about why some people give antibiotics. Post strep GN seems to be an issue in Canada that is not the case in the UK.
I did some back of the envelope calculations - which may or may not be accurate!
It would seem we need in primary care
1. The current prevalence of strep in patients presenting with sore throat
2. the incidence of post strep GN in our population
While we don't have this data then Robbie (see below) has an approach - which in effect is a three armed trial.
So - is anyone doing this - Anthony Harnden & David Mant in Oxford?
Bruce Arrol NZ?
If not should we do a worldwide study - 20 centres - we might need several million sore throats or more - I have not done a sample size calculation
so we would need $5.3 million to do this. I was thinking of Gates.
Martin
Karen
In Sydney the children's hospital saw 37 cases over 16 years. The population is currently 4 million
The population of children conservatively is about 10% so 400,000
So if the incidence of sore throat is 100/1000 person years then the rate of post strep GN is around 1 to 7 cases per 10,000 strep throats or 1 to 7 per 40 to 50,000 sore throats.
If you look after an average list of 2000 people with 200 kids then you will see 20 kids with sore throat. Do a walk in and you may see 200 - possibly 400. So say 100 out of 400 are strep.
The rate is maybe 7 per 10,000 strep - say its 1 per 1000 - that would be one every 10 years at the absolute maximum.
To cover the post strep GN eventuality you would have to give 1000 kids with strep antibiotics (that's the minimum number needed to treat (NNT) to prevent one case ) - If one was to give antibiotics to an extra 25% who did not have strep but had sore throat you are giving antibiotics to about 2000 kids to prevent one case of post strep GN.
But I maximised figures so it might be an NNT of between 2,000 to 4,000 to prevent one case of post strep GN
Martin
________________________________
Is the virulence of Strep higher in Canada than in the UK?
So the question is do we have enough energy to pursue this. Has anyone an interest in infectious disease - UBC, Mac, ??
Martin
On 13/04/09 11:52 AM, "Robbie Coull" <[log in to unmask]> wrote:
The UK discussion is running along the lines of:
-there was no evidence that appearance or presentation can differentiate
between viral and bacterial sore throat.
-either you routinely give antibiotics for all sore throats to prevent
the occasional bacterial complication and that a 10 day course is
necessary to reduce the risk of rheumatic fever or nephritis [although,
I note that Canadian GPs seem fond of exotic antibiotics first line,
while UK doctors use pen V or amox - the latter assuming that mono is
not being considered).
- or swab all sore throats - and overnight you will at least be able to
tell which patients are colonised with strep (tho not if it is the cause
of their acute illness) and just treat THEM.
- or you advise them all about complications and ask to see them again
if they show any signs.
With the low virulence of Strep in the UK in our working lifetimes the
last one has been the best approach.
The virulence is considerably higher in the States (or deprivation and
susceptibility was higher - no-one seems quite sure!) and they opt for
one of the first two options.
Is the virulence of Strep higher in Canada than in the UK?
--
Robbie Coull, Charlottetown PE
http://blog.oscarpei.net
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