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Meta-analysis of trials of streptococcal throat treatment programs to prevent rheumatic fever

Pediatr Infect Dis J. 2009 Jul;28(7):e259-64.

Lennon D, Kerdemelidis M, Arroll B.

Community Paediatrics, University of Auckland, Auckland, New Zealand.d.lennon@auckland.ac.nz

BACKGROUND: Rheumatic fever (RF) is the commonest cause of pediatric heart disease globally. Penicillin for streptococcal pharyngitis prevents RF. Inequitable access to health care persists. 

PURPOSE: To investigate RF prevention by treating streptococcal pharyngitis in school- and/or community-based programs. 

DATA SOURCES: Medline, Old Medline, the Cochrane Library, DARE, Central, NHS, EED, NICE, NRMC, Clinical Evidence, CDC website, PubMed, and reference lists of retrieved articles. Known researchers in the field were contacted where possible. 

METHODS: Randomized, controlled trials or trials of before/after design examining treatment of sore throats in schools or communities with RF as an outcome where data were able to be pooled for analysis. Two authors examined titles, abstracts, selected articles, and extracted data. Disagreements were resolved by consensus. 

QUANTITATIVE ANALYSIS TOOL: Review Manager version 4.2 to assess pooled relative risks and 95% confidence intervals. 

DATA SYNTHESIS: Six studies (of 677 screened) which met the criteria and could be pooled were included. Meta-analysis of these trials for RF control produced a relative risk of 0.41 (95% CI: 0.23-0.70). There was statistical heterogeneity (I = 70.5%). Hence a random effects analysis was conducted.

 LIMITATIONS: Many studies were poor quality. Title and available abstracts of non-English studies were checked. There may be publication bias. This is the best available evidence in an area with imperfect information. 

DISCUSSION: It is expected acute RF cases would diminish by about 60% using a school or community clinic to treat streptococcal pharyngitis. This should be considered in high-risk populations.

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