Prevalence and Epidemiology of Group A B-Hemolytic Streptococcus (GABHS) Among Young School-Age Children with Tonsillopharyngitis in Northern Palestine: A Cross- Sectional Study

Abstract

Abstract Introduction: Tonsillopharyngitis is a common diagnosis in children, it is mainly caused by viral pathogens. GABHS is the most common bacterial cause, and it is often overestimated as a causative agent because diagnosis often relies on clinical judgment, leading to the overuse of broad-spectrum antibiotics. The study aims to evaluate the prevalence of GABHS in children clinically diagnosed with pharyngitis/tonsillitis. Objectives include determining the prevalence in our area and assessing antibiotic sensitivity. Methods: A non-interventional cross-sectional study on children aged 5–15 who were clinically diagnosed with tonsillopharyngitis. Throat swab samples were collected from patients diagnosed with pharyngitis/tonsillitis at 3 major healthcare centers in north Palestine. The samples were evaluated for the presence of GABHS through a swab culture on blood agar and RADT for Streptococcus. A structured questionnaire was used to collect data from patients, their families, and treating physicians Results: A cohort of 321 patients presenting with clinical symptoms suggestive of tonsillitis/pharyngitis to the enrolled healthcare centers from September 2022 to January 2023, and meeting the inclusion criteria, were evaluated in this study. Of these patients, 30.8% tested positive on a Rapid Antigen Test, and 23.4% were confirmed to have GABHS based on culture results. Penicillin was identified as the most effective antibiotic with a sensitivity rate of 97.3%, followed by Amoxicillin-Clavulanic Acid with a sensitivity rate of 96%, while Azithromycin was the least effective antibiotic. These results provide guidance for the selection of appropriate antibiotics for the treatment of GABHS-induced tonsillitis/pharyngitis. Conclusion Among patients with tonsillitis infections, the prevalence of GABHS was determined to be 23.4%. If antibiotic therapy is warranted, Amoxicillin/Clavulanic Acid and Penicillin are the recommended drugs of choice.