Antibiotic Conservation
Aotearoa
Overall, GAS was isolated from 13% of 1.25 million throat swabs collected from people presenting to community healthcare providers in Auckland during 2010-2016. There was no way of knowing whether isolation of GAS from a throat swab reflected acute GAS pharyngitis, or pharyngitis that was due to a viral infection in a person with pre-existing asymptomatic GAS colonisation. The mean annual incidence of isolation of GAS was approximately 10% in Pacific people, 8% in Maori people 6% in European people and 3% in Asian people. The different percentages of the population who had GAS isolated may be largely due to different rates of consultation for a sore throat, rather than different rates of infection.
During the same period the incidence of first hospitalisation for acute rheumatic fever (ARF) was approximately 100/105 population in Pacific people, 35/105 in Maori, and less than 1/105 in people of other ethnicities. Higher rates of testing for GAS infection in Maori and Pacific people might be expected to result in higher rates of prescribing for patients with GAS pharyngitis, and thus reduce the incidence of ARF. In contrast current high rates of testing for GAS in people of other ethnicities appear excessive in relation to their risk of ARF. Reducing the rates of throat swab testing in these people would be extremely unlikely to result in increased rates of rheumatic fever and would be a good way to reduce unproductive work and expense for the health system and for our patients.
