Diagnosis And Treatment Of Streptococcal Pharyngitis
BETH A. CHOBY, MD, University of Tennessee College of MedicineChattanooga, Chattanooga, Tennessee
Am Fam Physician. 2009 Mar 1 79:383-390.
Patient information: See related handout on strep throat, written by the author of this article.
Pharyngitis is diagnosed in 11 million patients in U.S. emergency departments and ambulatory settings annually.1 Most episodes are viral. Group A beta-hemolytic streptococcus , the most common bacterial etiology, accounts for 15 to 30 percent of cases of acute pharyngitis in children and 5 to 20 percent in adults.2 Among school-aged children, the incidences of acute sore throat, swab-positive GABHS, and serologically confirmed GABHS infection are 33, 13, and eight per 100 child-years, respectively.3 Thus, about one in four children with acute sore throat has serologically confirmed GABHS pharyngitis. Forty-three percent of families with an index case of GABHS pharyngitis have a secondary case.3 Late winter and early spring are peak GABHS seasons. The infection is transmitted via respiratory secretions, and the incubation period is 24 to 72 hours.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
Use of clinical decision rules for diagnosing GABHS pharyngitis improves quality of care while reducing unwarranted treatment and overall cost.
GABHS = group A beta-hemolytic streptococcus.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
GABHS = group A beta-hemolytic streptococcus.
How To Protect Others
- Everyone should wash hands often with soap or hand sanitizer. Good handwashing prevents the spread of infection.
- Cover the mouth when coughing or sneezing. Give your child a paper bag and have him put his used tissues in the bag. Moisture from the child’s nose and mouth is contagious.
- Do not share drinking cups or eating utensils.
- Throw away your child’s toothbrush and buy a new one as soon as the illness is over.
- Keep your child away from others for 24 hours after the medicine is started and until he has no fever.
- Tell the school nurse and your childs teacher that your child has strep throat. It is important for school personnel to know so that other parents can be told to watch for symptoms in their children.
- If anyone in the family gets a sore throat, he should be checked by a doctor to see if medical treatment is needed.
Protect Yourself And Others
People can get strep throat more than once. Having strep throat does not protect someone from getting it again in the future. While there is no vaccine to prevent strep throat, there are things people can do to protect themselves and others.
Good Hygiene Helps Prevent Group A Strep Infections
The best way to keep from getting or spreading group A strep is to wash your hands often. This is especially important after coughing or sneezing and before preparing foods or eating. To practice good hygiene, you should:
- Cover your mouth and nose with a tissue when you cough or sneeze
- Put your used tissue in the waste basket
- Cough or sneeze into your upper sleeve or elbow, not your hands, if you dont have a tissue
- Wash your hands often with soap and water for at least 20 seconds
- Use an alcohol-based hand rub if soap and water are not available
You should also wash glasses, utensils, and plates after someone who is sick uses them. These items are safe for others to use once washed.
Wash your hands often to help prevent germs from spreading.
Antibiotics Help Prevent Spreading the Infection to Others
People with strep throat should stay home from work, school, or daycare until they:
- No longer have a fever
- Have taken antibiotics for at least 12 hours
Take the prescription exactly as the doctor says to. Dont stop taking the medicine, even if you or your child feel better, unless the doctor says to stop.
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Medication That Can Suppress The Immune System
Carbimazole is a medicine that is used to treat an overactive thyroid gland. If you are taking carbimazole and develop a sore throat then you should have an urgent blood test. This is because a sore throat may be the first warning of a serious side-effect to carbimazole . This serious side-effect needs urgent treatment. Other medication, such as chemotherapy for cancer, or certain tablets called disease-modifying antirheumatic drugs , can also affect the way your immune system copes with infection. If you are taking one of these types of medication and develop a sore throat, see your doctor urgently. They will arrange an immediate blood test.
The ‘take home’ message is … see a doctor if symptoms of a sore throat are severe, unusual, or do not ease within one week. In particular, seek urgent medical attention if you develop:
- Difficulty in breathing.
- A persistent high temperature .
- A severe illness, especially when symptoms are mainly on one side of the throat.
How A Sore Throat Is Diagnosed
During the exam, the doctor will ask about your symptoms, and will use a light to check the back of your throat for redness, swelling, and white spots. The doctor might also feel the sides of your neck to see if you have swollen glands.
If the doctor suspects you have strep throat, youll get a throat culture to diagnose it. The doctor will run a swab over the back of your throat and collect a sample to test for strep throat bacteria. With a rapid strep test, the doctor will get the results within minutes.
To confirm the diagnosis, the sample will be sent out to a lab to be tested. A lab test takes one to two days, but it can definitively show that you have strep throat.
Sometimes you might need more tests to figure out the cause of your sore throat. You can see a specialist who treats diseases of the throat, called an ear, nose, and throat doctor or otolaryngologist.
Doctors diagnose strep throat based on symptoms, an exam of the throat, and a strep test. For a sore throat without an obvious diagnosis, you might need to see a specialist who treats conditions of the ears, nose, and throat.
You can take medicines to relieve the pain of a sore throat, or to treat the underlying cause.
Over-the-counter medications that relieve throat pain include:
Dont give aspirin to children and teenagers, as its been linked to a rare but serious condition called Reyes syndrome.
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Children And Certain Adults Are At Increased Risk
Anyone can get strep throat, but there are some factors that can increase the risk of getting this common infection.
Strep throat is more common in children than adults. It is most common in children 5 through 15 years old. It is rare in children younger than 3 years old. Adults who are at increased risk for strep throat include:
- Parents of school-aged children
- Adults who are often in contact with children
Close contact with another person with strep throat is the most common risk factor for illness. For example, if someone has strep throat, it often spreads to other people in their household.
Infectious illnesses tend to spread wherever large groups of people gather together. Crowded conditions can increase the risk of getting a group A strep infection. These settings include:
- Up to 3 in 10 children with a sore throat have strep throat
- About 1 in 10 adults with a sore throat has strep throat
What Are The Risks Of Taking Antibiotics For Sore Throat
Antibiotics may cause side effects, such as diarrhea, vomiting, and skin rashes.
Besides side effects, there are other good reasons not to use antibiotics unless you really need them.
- Antibiotics cost money.
- You will probably have to see the doctor to get a prescription. This costs you time.
- If you take antibiotics when you don’t need them, they may not work when you do need them. Each time you take antibiotics, you are more likely to carry some bacteria that were not killed by the medicine. Over time, these bacteria get tougher and can cause longer and more serious infections. To treat them, you may need different, stronger, and more costly antibiotics.
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Do I Need An Antibiotic
The teams at Pew, the Centers for Disease Control and Prevention, the University of Utah and elsewhere chose ear infections, sore throats and sinus infections because they generate 44 million antibiotic prescriptions a year.
Its only appropriate sometimes to prescribe antibiotics for these conditions. Strep throat is easily treated with antibiotics, and if a child with a middle ear infection has pus oozing out, a pediatrician will usually give an antibiotic. Sinus infections that linger may be helped with antibiotics.
But more sore throats and ear infections are caused by viruses, and an antibiotic will do nothing to help the patient. Sinus infections can sometimes involve bacteria but often are caused by viruses or fungi.
When an antibiotic is called for, it should be a basic one usually amoxicillin, the Pew team said. Thats not what people usually get, however.
The most commonly prescribed non-first-line antibiotics for sinus infections, middle ear infections and pharyngitis were macrolides , a class of broad-spectrum antibiotics frequently prescribed in outpatient settings, the Pew team wrote in their report.
However, macrolides are not recommended for sinus or middle ear infections and are recommended for pharyngitis only for patients with an allergy to the penicillin class of antibiotics.
Why would doctors prescribe the wrong drug?
How To Get Rid Of A Sore Throat Fast Overnight
1.) Gargle With Salt Water.
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Treating Strep Throat With Z
If your doctor thinks azithromycin is a good choice for you, they may prescribe a generic version of azithromycin or a Z-Pack.
Each Z-Pack contains six 250-milligram tablets of Zithromax. You would take two tablets on the first day, followed by one tablet daily for four days.
A Z-Pack typically takes at least five days to fully work, but it can start to relieve your sore throat and other symptoms on the first day you take it. If your doctor prescribes a generic version of azithromycin, your treatment may only last three days.
Be sure to take your Z-Pack or generic azithromycin exactly as your doctor prescribes. This is true even if you feel better before youve taken the full course of treatment.
If you stop taking an antibiotic early, it could make the infection come back or make future infections more difficult to treat.
What Is A Sore Throat
Sore throats can be painful and annoying. But most of the time they go away on their own. It may take a few days or up to a week, depending on the cause.
Most sore throats are caused by a virus, such as a cold. A bacterial infection can also cause a sore throat.
If you have a sudden, severe sore throat without coughing, sneezing, or other cold symptoms, you could have strep throat. Strep throat is a bacterial infection of the throat and tonsils. About 1 out of 10 sore throats in adults is caused by strep throat. This means that 9 out of 10 sore throats aren’t strep.
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How To Treat A Sore Throat Yourself
To help soothe a sore throat and shorten how long it lasts, you can:
- gargle with warm, salty water
- drink plenty of water
- eat cool or soft foods
- avoid smoking or smoky places
- suck ice cubes, ice lollies or hard sweets but do not give young children anything small and hard to suck because of the risk of choking
What Is Rheumatic Fever
Rheumatic fever can develop following a Strep throat infection or scarlet fever. Although rare in the contiguous U.S., the disease is still prevalent in children of Samoan descent living in Hawaii and residents of American Samoa.
Symptoms of rheumatic fever usually show 14 to 28 days after a Strep infection. Because the bacteria trick the body’s immune system into attacking healthy tissues, the disease can affect the heart, joints, skin, and brain.
Symptoms of rheumatic fever include:
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How You Get Strep Throat
Group A strep live in the nose and throat and can easily spread to other people. It is important to know that some infected people do not have symptoms or seem sick. People who are infected spread the bacteria by coughing or sneezing, which creates small respiratory droplets that contain the bacteria.
People can get sick if they:
- Breathe in those droplets
- Touch something with droplets on it and then touch their mouth or nose
- Drink from the same glass or eat from the same plate as a sick person
- Touch sores on the skin caused by group A strep
Rarely, people can spread group A strep through food that is not handled properly . Experts do not believe pets or household items, like toys, spread these bacteria.
A Simple Test Gives Fast Results
Only a rapid strep test or throat culture can determine if group A strep is the cause. A doctor cannot tell if someone has strep throat just by looking at his or her throat.
A rapid strep test involves swabbing the throat and running a test on the swab. The test quickly shows if group A strep is causing the illness. If the test is positive, doctors can prescribe antibiotics. If the test is negative, but a doctor still suspects strep throat, then the doctor can take a throat culture swab. A throat culture takes time to see if group A strep bacteria grow from the swab. While it takes more time, a throat culture sometimes finds infections that the rapid strep test misses. Culture is important to use in children and teens since they can get rheumatic fever from an untreated strep throat infection. For adults, it is usually not necessary to do a throat culture following a negative rapid strep test. Adults are generally not at risk of getting rheumatic fever following a strep throat infection.
Someone with strep throat should start feeling better in just a day or two after starting antibiotics. Call the doctor if you or your child are not feeling better after taking antibiotics for 48 hours.
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Personal Stories About Taking Antibiotics For Sore Throat
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I was sick a lot as a kid, and I was always taking medicine. Maybe it helped at the time. But in the past few years, when I’ve gotten a bad sore throat or sinus infection, antibiotics haven’t worked. I’ve had to try two or three different ones each time. That gets expensive. The next time I get a sore throat, I’m going to try just staying home, resting, and taking care of myself instead of taking antibiotics.
My 8-year-old daughter got strep throat last month. I thought it was just a cold, and I kept her home from school for a few days. But she wasn’t getting better and she felt so miserable. I was also worried about ear infections. She gets a lot of those too. The doctor did a strep test and suggested she take antibiotics. Amy started feeling better a few days later. I think antibiotics were the right way to go this time.
My insurance doesn’t pay for all of my medicines, so I try to make sure I really need the ones I do take. The last time I had a bad cold, my throat got really sore. The pain made it hard for me to swallow. I called my doctor’s office and the nurse said I could come in if I felt I needed a prescription. I thought I’d wait and see instead. I took ibuprofen and drank a lot of tea and honey, and in a few days I felt better. I’m glad I didn’t spend the money on a doctor visit and medicine.
What Are The Recommended Dosages Of Antibiotics Used To Treat Strep Throat
Antibiotic dosages can vary depending on age and weight. The CDC recommends the following dosages of antibiotics for Strep throat, for those people without a penicillin allergy. One dosage regimen should be chosen that is appropriate for the person being treated.
Oral Penicillin V
- Children: 250mg twice daily or 250mg three times daily for 10 days
- Adolescents and adults: 250mg four times daily or 500mg twice daily for 10 days
- Children and adults: 50 mg/kg once daily for 10 days
- Children and adults: 25 mg/kg twice daily for 10 days
Intramuscular Benzathine penicillin G
- Children < 27 kg: 600 000 units as a single dose
- Children and adults 27 kg: 1 200 000 units as a single dose
The CDC recommends the following dosages of antibiotics for Strep throat, for those people with a penicillin allergy. One dosage regimen should be chosen that is appropriate for the person being treated.
- Oral cephalexin 20 mg/kg twice daily for 10 days
- Oral cefadroxil 30 mg/kg once daily for 10 days
- Oral clindamycin 7 mg/kg three times daily for 10 days
- Oral azithromycin 12 mg/kg once daily for the first day , followed by 6 mg/kg once daily for the next 4 days
- Oral clarithromycin 7.5 mg/kg twice daily for 10 days.
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