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in so-called developed countries&#44; the incidence of ARF decreased significantly until it all but disappeared&#46; But ARF continues to be an important health problem in low-income countries and also in disadvantaged areas in middle- and high-income countries&#46; Since we do not know the exact reasons for the historical decline of ARF&#44; we cannot fully anticipate the potential results of a generalised reduction in the duration of antibiotherapy&#46; In any case&#44; this approach would not be appropriate in populations in which the risk of ARF and rheumatic heart disease continue to be high&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A 5- to 7-day course for treatment of streptococcal pharyngitis can generally prevent suppurative complications&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> but it does not eradicate the bacterium&#46; This has to be taken into account in at-risk groups or when GAS needs to be eradicated&#46; It is important to remain vigilant for outbreaks of disease&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">At present&#44; in the autumn of 2022&#44; we are observing what may be an increase in the number of streptococcal infections in the United Kingdom<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and other countries&#44; including cases of scarlet fever and infection by invasive strains&#46; Reports of invasive disease chiefly correspond to individuals aged more than 75 years &#40;2&#46;4 cases per 100 000&#41;&#44; children aged 1&#8211;4 years &#40;2&#46;3&#41;&#44; infants under 1 year &#40;1&#46;3&#41; and children aged 5&#8211;9 years &#40;1&#46;1&#41;&#46; This could reflect an increase in respiratory viruses &#40;especially influenza viruses and respiratory syncytial virus&#41;&#59; there may be other causes&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">This phenomenon was seen in previous decades&#46; In fact&#44; Gonz&#225;lez-Abad and Alonso<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> reported an increase in cases in Spain between 2011 and 2018&#58; 29 cases of invasive <span class="elsevierStyleItalic">Streptococcus pyogenes</span> &#40;in blood&#44; pleural fluid and other sites&#41; were documented&#46; Between 2011 and 2013&#44; a single strain was documented per year&#44; but from 2014 to 2018&#44; 2&#44; 5&#44; 4&#44; 6 and 9 strains were identified each successive year&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">While acknowledging the value of the work of Salinas-Salvador et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> we would like to underscore the ever-shifting nature of the epidemiology of viral and bacterial infections and the need to keep a close watch of their incidence and severity&#46; Viral infections are associated with a risk of bacterial complications&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Epidemic outbreaks must be notified to the health care authorities&#46; It is worth noting that ARF was a reportable disease in Spain from 1951 to 1996 &#40;BOE no&#46; 21&#44; 24 January 1996&#44; p&#46; 2153&#41;&#46; Although some autonomous communities maintained it as a reportable disease for a few more years&#44; it was only until 2006 &#40;Appendix I of Order SAN&#47;2128&#47;2006&#44; of 27 December&#44; regulating the reportable disease system of Castilla-Leon&#41;&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This research did not receive any external funding&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Letter to the Editor
Letter to the Editor of Anales de Pediatría (Barc) about the work of Salinas-Salvador et al. “Retrospective study on the effectiveness and safety of the shortened 5- to 7-day antibiotic regimen for acute streptococcal pharyngotonsillitis compared to the classic 10-day regimen”
Carta a la editora de anales de pediatría (barc) sobre el trabajo de salinas-salvador y colaboradores «estudio retrospectivo sobre la efectividad y seguridad de la pauta antibiótica reducida a 5–7 días en la faringoamigdalitis agudaestreptocócica comparada con la pauta clásica de 10 días»
Miguel Ángel Zafra Antaa,b,
Corresponding author
miguel.zafra@salud.madrid.org

Corresponding author.
, Víctor Manuel García Nietob,c
a Servicio de Pediatría, Hospital Universitario de Fuenlabrada, Miembro del Grupo de Historia de la Pediatría de la AE, Fuenlabrada, Madrid, Spain
b Grupo de Historia de la Pediatría de la AEP, Spain
c Director de Canarias Pediátrica, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">After carefully reading the work of Salinas-Salvador et al&#46;&#44; Estudio retrospectivo sobre la efectividad y seguridad de la pauta antibi&#243;tica reducida a 5&#8211;7 d&#237;as en la faringoamigdalitis aguda estreptoc&#243;cica comparada con la pauta cl&#225;sica de 10 d&#237;as&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> on a study of 2 paediatric caseloads in a primary care centre of Zaragoza conducted between June 2016 and April 2020&#44; we consider that it is in line with the current trend of recommending a reduced course of antibiotherapy for the management of pharyngitis caused by group A beta-haemolytic streptococci &#40;GAS&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Recently&#44; we reviewed the history of the decline of acute rheumatic fever &#40;ARF&#41; in environments with an adequate public health system&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In the 20th century&#44; in so-called developed countries&#44; the incidence of ARF decreased significantly until it all but disappeared&#46; But ARF continues to be an important health problem in low-income countries and also in disadvantaged areas in middle- and high-income countries&#46; Since we do not know the exact reasons for the historical decline of ARF&#44; we cannot fully anticipate the potential results of a generalised reduction in the duration of antibiotherapy&#46; In any case&#44; this approach would not be appropriate in populations in which the risk of ARF and rheumatic heart disease continue to be high&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A 5- to 7-day course for treatment of streptococcal pharyngitis can generally prevent suppurative complications&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> but it does not eradicate the bacterium&#46; This has to be taken into account in at-risk groups or when GAS needs to be eradicated&#46; It is important to remain vigilant for outbreaks of disease&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">At present&#44; in the autumn of 2022&#44; we are observing what may be an increase in the number of streptococcal infections in the United Kingdom<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and other countries&#44; including cases of scarlet fever and infection by invasive strains&#46; Reports of invasive disease chiefly correspond to individuals aged more than 75 years &#40;2&#46;4 cases per 100 000&#41;&#44; children aged 1&#8211;4 years &#40;2&#46;3&#41;&#44; infants under 1 year &#40;1&#46;3&#41; and children aged 5&#8211;9 years &#40;1&#46;1&#41;&#46; This could reflect an increase in respiratory viruses &#40;especially influenza viruses and respiratory syncytial virus&#41;&#59; there may be other causes&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">This phenomenon was seen in previous decades&#46; In fact&#44; Gonz&#225;lez-Abad and Alonso<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> reported an increase in cases in Spain between 2011 and 2018&#58; 29 cases of invasive <span class="elsevierStyleItalic">Streptococcus pyogenes</span> &#40;in blood&#44; pleural fluid and other sites&#41; were documented&#46; Between 2011 and 2013&#44; a single strain was documented per year&#44; but from 2014 to 2018&#44; 2&#44; 5&#44; 4&#44; 6 and 9 strains were identified each successive year&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">While acknowledging the value of the work of Salinas-Salvador et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> we would like to underscore the ever-shifting nature of the epidemiology of viral and bacterial infections and the need to keep a close watch of their incidence and severity&#46; Viral infections are associated with a risk of bacterial complications&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Epidemic outbreaks must be notified to the health care authorities&#46; It is worth noting that ARF was a reportable disease in Spain from 1951 to 1996 &#40;BOE no&#46; 21&#44; 24 January 1996&#44; p&#46; 2153&#41;&#46; Although some autonomous communities maintained it as a reportable disease for a few more years&#44; it was only until 2006 &#40;Appendix I of Order SAN&#47;2128&#47;2006&#44; of 27 December&#44; regulating the reportable disease system of Castilla-Leon&#41;&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This research did not receive any external funding&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Anales de Pediatría (English Edition)