Publication: The association between the sore throat and group C beta-haemolytic streptococci - A systematic review and meta-analysis

The association between the sore throat and group C beta-haemolytic streptococci - A systematic review and meta-analysis.
Manchal N, Gunnarsson R.
Oslo: General Practice Research on Infections meeting (GRIN); 2017.


Context: A sore throat is a common reason for patients to attend primary health care. Although most cases of pharyngitis are viral in origin, the role played by bacteria like Group C beta-hemolytic streptococcus (GCS) is unclear. In the era of antibiotic resistance, it is imperative that antibiotics are only prescribed if there is a strong link between this bacterium and the sore throat. Objective: The aim of the study was to ascertain if GCS should be considered as a pathogen in sporadic cases of uncomplicated sore throat. This objective was studied in adults and children separately. Design: A systematic review of studies on GCS associated pharyngitis and a meta-analysis to calculate the cumulative positive (P-EPV) and negative (N-EPV) etiologic predictive value of presence or absence of GCS in the throat. Setting: Included studies were conducted in a primary health care setting. Patients: All prospective and retrospective studies with GCS and community acquired sore throat were included. The studies had to be published in English. Information had to be presented for children from 3-18 years and adults above 18yrs separately. Studies with patients already treated with antibiotics, case reports, GCS infections other than pharyngitis and those with immune compromised patients were not included. Results: The cumulative P-EPV of a throat swab was 54% (95% CI 38-67%) in adults when only including studies with comparative healthy controls. There was no point in calculating cumulative P-EPV for children as the prevalence of GCS was identical among patients and healthy controls. Conclusions: There is enough evidence to ignore GCS as a pathogen in otherwise healthy children with an uncomplicated sore throat and throat swabs taken in these children should not aim to identify GCS. In adults a finding of GCS indicates a 54% chance for this bacterium to truly be associated with the sore throat indicating a weak association that should only be of potential interest in immunocompromised patients.

, from FoU-centrum för primärvård och folktandvård Södra Älvsborg