[Characteristics of the group A streptococcal (GAS) epidemic in the pediatric primary care in Hungary in 2023].

Introduction and objective: A rising number of group A streptococcal infections has been observed all over Europe since 2022. In addition to the high number of patients, the increase in the proportion of progressive, severe, invasive cases has been noticed as an alarming problem. The aim of our study was to describe the characteristics of the Hungarian Streptococcus pyogenes epidemic in the paediatric primary care setting, based on a questionnaire covering a large cohort of paediatric patients. Methods: A 21-item structured questionnaire was sent out on the general physician network platform to primary care paediatricians nationwide in May 2024. The questionnaire was retrospective, assessing actual diagnostic and treatment strategies for streptococcal diseases identified between 1 January and 31 December 2023. Results: Based on data from a total of 71,600 children in 72 paediatric practices, 8.5% (95% confidence interval: 7.1–9.9%) of the enrolled children were diagnosed with streptococcal tonsillitis and/or scarlet fever (n = 6110), of which a quarter of the infected children (2.1%; 95% confidence interval: 1.74–2.46%) showed symptoms of scarlet fever (n = 1515). 82% of the patients were in the age group 5–10 years. Peritonsillar abscesses developed in 0.6% of patients (41 cases), invasive disease was diagnosed in 9 children, post-streptococcal glomerulonephritis occurred in 2 children, while reinfection was observed in an average of 15%. In nearly half of the suspected cases (47%), diagnostic microbiological tests were carried out. In terms of therapeutic strategy, the most commonly used antibiotic was amoxicillin-clavulanic acid (41%), but the combined use of narrower spectrum beta-lactams (penicillin, amoxicillin, cefprozil) reached 50%. Macrolide was used by 6%, cefixime by 3%. Discussion: In the current streptococcal epidemic point-of-care diagnosis, early recognition of invasive diseases and appropriate antibiotic selection are crucial for both clinical outcome and antibiotic stewardship. Our results suggest that greater use of rapid testing and the promotion of early, narrow-spectrum antibiotic treatment in proven cases should be encouraged. Conclusion: Our study provides feedback to primary care paediatricians on diagnostic and therapeutic practices and emphasizes the importance of adequate antibiotic selection and early recognition of invasive S. pyogenes infections. Orv Hetil. 2025; 166(19): 719–727.