A message from Paul Gilluley, Chief Medical Officer, NHS North East London
Dear Colleague
There is pressure on the system at the moment particularly with very sick young children. Many worried parents are contacting you and your practice for advice on their unwell child. This is on top of an already pressurised system.
On Friday, the UK Health Security Agency issued advice regarding the increase in invasive group A streptococcus (iGAS) infections, including empyema, in children. For primary healthcare this included the following:
Recommendations for Primary Care
- Given the unusually high level of GAS and viral co-circulation in the community, health care professionals are asked to have a low threshold to consider and empirically prescribe antibiotics (penicillin is first line therapy) to children presenting with features of GAS infection, including where secondary to viral respiratory illness.
- When indicated, a throat swab should be sent for culture and antimicrobial susceptibility testing.
- For children unable to take penicillin-based regimes, susceptibility testing results should be reviewed given rates of resistance to clindamycin and macrolides.
- Parents of children with presumed respiratory viral infection should be made aware of features suggestive of secondary bacterial infection, such as clinical deterioration, and when and how to seek further help. Safety netting advice for parents can be found here.
- GPs should maintain a low threshold for prompt referral to secondary care of any children presenting with persistent or worsening symptoms.
The website, Healthier Together endorsed by the Royal College of Paediatrics and Child Health (RCPCH) has this helpful parent/carer information on Strep A and Scarlet Fever https://what0-18.nhs.uk/parentscarers/worried-your-child-unwell/scarlet-fever
Thank you for all the work you are doing at the moment to manage this surge in demand. Locally there are arrangements being put in place to increase access to primary healthcare so the demand can be managed.
We will keep you updated on any further guidance.
Yours sincerely
Paul Gilluley