Group A Streptococcal Infections—Diagnostic Approaches and Antibiotics Prescriptions in Children and Adolescents in Germany: A Nationwide Representative Claims Data Analysis
Author(s)
Janina Soler Wenglein, M.D.1, Lisa Wandschneider, PhD2, Lena Hasemann, MPH (M.Sc.)3, Jana Diekmannshemke, DS (MSc)3, Malte Klee, M.D.4, Reinhard Berner, Prof., M.D.5, Nicole Töpfner, M.D.5.
1Department of Pediatrics, Protestant Hospital of the Bethel Foundation, Medical School and University Medical Center OWL, Bielefeld University, Bielefeld, Germany, 2Bielefeld, Germany, 3VANDAGE, Bielefeld, Germany, 4DAK-Gesundheit, Hamburg, Germany, 5Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
1Department of Pediatrics, Protestant Hospital of the Bethel Foundation, Medical School and University Medical Center OWL, Bielefeld University, Bielefeld, Germany, 2Bielefeld, Germany, 3VANDAGE, Bielefeld, Germany, 4DAK-Gesundheit, Hamburg, Germany, 5Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
OBJECTIVES: Group A Streptococcus (GAS) remains a significant pediatric health concern, with clinical outcomes ranging from minor infections to life-threatening invasive diseases. This study aimed to estimate the incidence of GAS infections, exemplary for tonsillopharyngitis and scarlet fever, and evaluate diagnostic interventions as well as antibiotic prescribing patterns in children and adolescents in Germany, in times of shifting public health dynamics during and after the COVID-19 pandemic.
METHODS: This retrospective analysis uses German nationwide-representative social health insurance claims data covering January 2019 to December 2023. We include children and adolescents aged 0-17 years, equating to approx. 800.000 individuals per year of observation. We calculated incidence rates and assessed diagnostic test utilization, antibiotic prescriptions, stratified by age and sex.
RESULTS: GAS incidence sharply declined during the COVID-19 pandemic but rebounded post-pandemic, surpassing 2019 levels in 2023 (8 per 1.000 children and adolescents in Q4, 2023). Antibiotic prescription rates per diagnosis dropped to a minimum of 80% (Q1, 2021) during the pandemic (vs. coverage rates of 92% pre- and post-pandemic). While most antibiotic prescriptions were preceded by rapid diagnostic tests, about one-third lacked documented diagnostic confirmation, ranging between 1,300 to 3,500 cases per quarter (2023). Phenoxymethylpenicillin remained the most frequently prescribed antibiotic in approx. 40% of GAS infections until 2023, when amoxicillin, cephalosporins, and macrolides became more common (47% of all antibiotic prescriptions). In approximately 10% of cases, initial antibiotics were switched.
CONCLUSIONS: This real-world evidence highlights evolving patterns in pediatric GAS care and antibiotics prescriptions during a period of unprecedented health system disruption. Most pediatric GAS cases in Germany are managed with appropriate diagnostics and antibiotics, reflecting solid adherence to clinical standards. However, the potential to optimize care is highlighted —particularly in cases without diagnostic confirmation and in varying antibiotic choices. These findings suggest the need to promote consistent implementation of diagnostic and antibiotic stewardship.
METHODS: This retrospective analysis uses German nationwide-representative social health insurance claims data covering January 2019 to December 2023. We include children and adolescents aged 0-17 years, equating to approx. 800.000 individuals per year of observation. We calculated incidence rates and assessed diagnostic test utilization, antibiotic prescriptions, stratified by age and sex.
RESULTS: GAS incidence sharply declined during the COVID-19 pandemic but rebounded post-pandemic, surpassing 2019 levels in 2023 (8 per 1.000 children and adolescents in Q4, 2023). Antibiotic prescription rates per diagnosis dropped to a minimum of 80% (Q1, 2021) during the pandemic (vs. coverage rates of 92% pre- and post-pandemic). While most antibiotic prescriptions were preceded by rapid diagnostic tests, about one-third lacked documented diagnostic confirmation, ranging between 1,300 to 3,500 cases per quarter (2023). Phenoxymethylpenicillin remained the most frequently prescribed antibiotic in approx. 40% of GAS infections until 2023, when amoxicillin, cephalosporins, and macrolides became more common (47% of all antibiotic prescriptions). In approximately 10% of cases, initial antibiotics were switched.
CONCLUSIONS: This real-world evidence highlights evolving patterns in pediatric GAS care and antibiotics prescriptions during a period of unprecedented health system disruption. Most pediatric GAS cases in Germany are managed with appropriate diagnostics and antibiotics, reflecting solid adherence to clinical standards. However, the potential to optimize care is highlighted —particularly in cases without diagnostic confirmation and in varying antibiotic choices. These findings suggest the need to promote consistent implementation of diagnostic and antibiotic stewardship.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH117
Topic
Epidemiology & Public Health, Real World Data & Information Systems
Disease
Infectious Disease (non-vaccine), Pediatrics