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Scarlet fever boom, ran for tests and antibiotics

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Scarlet fever boom, ran for tests and antibiotics

An exponential growth in sales of tests for strep of 2,000% in 2023, hand in hand with a +38% in sales of amoxicillin, the antibiotic that cures it and of which the shortage continues throughout Italy. The numbers are the litmus test of the worries of parents grappling with “table tennis infections and reinfections that are prolonging outbreaks of pharyngitis and scarlet fever despite the fact that it is late May”.

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This is explained by Susanna Esposito, coordinator of the Infectious Diseases Technical Table of the Italian Society of Pediatrics who underlines: in the face of this “off-season peak, with children who are re-infected even after a short time, it is important to avoid do-it-yourself tampons”. Meanwhile, the alert continues due to the shortages of some drugs, while help against resistant infections could come from an old antibiotic dusted off.

The surge in group A strep throat and scarlet fever seen in recent months it is linked to an immunological debt in the population – explains Esposito, professor of pediatrics at the University of Parma – due to the lower circulation of pathogens during the Covid pandemic. Infections that often, with a “ping pong effect”, also return two or three times on the same child, leading to multiple courses of antibiotics in a few weeks”.

The numbers of Iqvia, provider of data and analysis in the health sector, speak for themselves: if in Italian pharmacies from October 2021 to March 2022 3,857 swabs were sold to detect this bacterium, from October 2022 to March 2023 there were 77,661, odds of +1.913%. Sales of amoxicillin are also growing, going from 11.9 million doses sold from November 2021 to March 2022 to 16.4 million from November 2022 to March 2023, equal to +38%. Hand in hand, denounces Andrea Mandelli, president of the Order of Pharmacists, “the shortage of this antibiotic has worsened in recent weeks, due to a 50% increase in streptococcus A infections”. When this infection manifests itself with fever and pharyngitis, “antibiotic therapy must be started immediately to avoid possible complications, including abscesses and rheumatic disease,” Esposito points out.

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Beware of “do-it-yourself” tampons

Do-it-yourself is highly discouraged in these cases. «The swab made at home does not have the same reliability as the one performed by an expert. Furthermore, the swab must be avoided in the absence of symptoms because healthy carriers should not be treated » continues Esposito. Respecting these rules is important to avoid prescriptions, not always necessary, of amoxicillin, an antibiotic for which Sip has already reported supply difficulties since November.

Selecting the patients to whom to prescribe the antibiotic is also important for curb the growth of resistant bacteria, which remains among the main public health concerns in Europe. A study published in PLOS Biology could offer a new way to fight multidrug-resistant infections with streptotriquine. Isolated in 1942, it was the first antibiotic to show potent activity against gram-negatives. It is also active against the most resistant pathogens and acts with a unique mechanism of inhibition of protein synthesis. Its development was abandoned because it was toxic to the kidneys but researchers from Harvard Medical School have now discovered a less toxic, albeit highly active, form.

The virologist Pregliasco: “With the lack of amoxicillin we need to find different molecules”

For the virologist Fabrizio Pregliasco, in this situation the doctor’s responsibility not to change the class and not to use those antibiotics to be preserved, those with a greater spectrum of action, is “very important”. So stay in the realm of beta-lactam antibiotics, of which penicillins are a part”. Speaking of the lack of amoxicillin, Pregliasco points out that «amoxicillin is one of the semi-synthetic penicillins. The responsibility is to find different molecules. Fortunately, there are some in this category: oxacillin, cloxacillin, nafcillin and piperacillin. So there are, I would say, many active ingredients, which also represent drugs with famous brands».

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