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Published on: 10/1/2006
Last Visited: 6/12/2008
Both Dr. Kaplan and Dr. Alan L. Bisno, an internist at the University of Miami School of Medicine and the Veterans Affairs Medical Center in Miami, say there are usually good ways for physicians and parents to distinguish between sore throats caused by a strep infection and those caused by a virus or some other bacterium.
Group A strep causes 15 percent to 30 percent of sore throats in children, Dr. Kaplan and Dr. Bisno reported in the September issue of Mayo Clinic Proceedings.
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Occasionally, strep infections "ping-pong" among family members, but "there's no strong evidence that the family pet is a source," Dr. Bisno said.
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Dr. Bisno explained that the examining physician has two options.The preferred course of treatment, as described in the 2002 practice guidelines of the Infectious Diseases Society of America, is to wait for the results of the throat culture before starting antibiotic therapy.The physician can write a prescription for antibiotics but suggest that it not be filled unless the throat culture is positive.
The second option, considered less than ideal, is to start antibiotic therapy right away and then stop it if the throat culture is negative, which almost always means the throat infection is caused by a virus, Dr. Bisno said.But, he added, this course of action is reasonable if, in spite of a negative result on the rapid test, "the child is really sick" with symptoms that suggest a strep infection.
An advantage of this option is that if the infection is indeed strep, 24 hours on an antibiotic renders the patient noncontagious, allowing a return to school or work after just a day's absence.
With or without treatment, Dr. Bisno said, strep infections are limited, and most people are better within three or four days.Furthermore, he said, it is safe to wait several days - and perhaps as many as nine days - before starting antibiotic therapy without compromising the chances of preventing rheumatic fever.
In addition, the decision to treat or not to treat can be simplified, Dr. Bisno said, if children with sore throats have symptoms of a cold - "no fever, no red throat, a runny nose and a cough."Such children, he said, "shouldn't be tested at all for strep" and should not be given antibiotics.
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