News about Strep Throat

Up until now our current practice has been to keep children at home for at least 24 hours after testing positive for strep and beginning antibiotics.  However, now a recent study published in the Pediatric Infectious Disease Journal demonstrated that children treated with amoxicillin can return to school the next day without putting other children at risk!

Here’s some info about sore throats in general:

Sore throats are one of the most common maladies in school aged children.  In fact 12 million annual visits to the doctor are made annually, the majority of them are caused by viruses, and these are self limited, don't require antibiotics, and always accompanied by other symptoms like runny nose, cough, congestion and sometimes fever.  However, those children with strep throat, a bacterial cause of pharyngitis, present differently. Their symptoms appear rapidly with sore throat, swollen glands, often a belly ache or vomiting (but no diarrhea), headache, and occasionally a sand papery rash called scarlatina. Although strep throat can resolve on its own after 3 days, it is ALWAYS treated with antibiotics.

How do you catch it?

It is spread from person to person through large droplets....ie with coughs, kisses, sharing food. It's even speculated, and I have seen, that it can be chronically carried on toothbrushes and even orthodontic appliances. Even your pets can carry strep and facilitate its spread.  So you can imagine those in close quarters are at greater risk. Family members of those with strep carry a 40% risk of becoming infected.


Why does it need to be treated even if it self resolves?

Strep is a unique bacteria in that it contains proteins that confuse the immune system, and left untreated can trigger a cascade of events that can lead to local and distant complications that can cause long term health problems.

On a local level strep can cause abscesses in the tonsils and surrounding structures, sinus infections, ear infection, and flesh eating infection (necrotizing fasciitis) or erysipelas...a painful deep skin infection.  On a distant level strep that is untreated can cause inflammation of the heart, joints, skin (called Rheumatic Fever) and even toxic shock syndrome and nephritis.

How is it detected?

Your doctor will test for it either by rapid strep tests or overnight culture.  If the rapid test is positive and the history and exam support the diagnosis then antibiotics can be started that day and continued for 10 days.  If your doctor only has overnight culture available, and the patient history and physical make the likelihood of strep greater, antibiotics are typically started, but may be withdrawn if the culture turns out negative. Keep in mind you should never ask for antibiotics for what your doc believes to be a viral sore throat....they won't get you better any faster and you will run the real risk of developing antibiotic resistance or drug allergy when using antibiotics unnecessarily.

How is Strep treated?

If a patient is not penicillin allergic, then penicillin or amoxicillin are used.  To date all strep is responsive to these simple and inexpensive medications.  For those who are allergic, there are many other options. And now that good science has shown us that ONCE DAILY oral amoxicillin is as effective as twice daily or penicillin 4 times daily, patients are likely to complete a full course of antibiotics, and now be able to return to school the next day.

So the guidelines are……

If your kid has had their once daily amoxicillin by 5 pm, they can return to school the next day, if no fever and feeling ok.  Of course if fever or pain is still present, keep him home another day. But with these new guidelines we will get more kids back to school earlier, and more working parents will be able to stay at work, as well.  That's a good thing!!

And lastly, a good practice after a viral or strep throat is to either discard your toothbrush, or give it a few minutes soak in some boiling water to kill off the germs.  With orthodontic appliances, soaking in alcohol for several minutes should do the trick.  Don’t let your kid’s toothbrushes “live” together in the same cup as yours or siblings…..the possible contact could lead to spread of germs in the family!