Strep throat is one of the most common infections during this time of the year likely due to kids heading back to school. We wanted to use this post as an opportunity to share with our readers some myths and facts every parent should know about strep infection this school year.
First, let’s begin with what it is strep throat?
Strep throat is a throat infection caused by Group A Beta Hemolytic Streptococcus (GAS).
While this infection can be very contagious, particularly in a school setting, it also more common in kids of a specific age group. As you read along, you’ll find out what are some common symptoms of strep, which age group is more likely to contract this infection, and what treatment options are available.
Our Pediatric Urgent Care clinics also sees children who have a cold, sinusitis, bronchitis, pink eye and urinary tract infection (UTI).
Let’s Jump In!
Infants & toddlers don’t get strep throat:
ANSWER: YES & NO
“Classic” Strep throat is very uncommon in infants and toddlers.
Children 3 years of age or less usually don’t or can’t complain of a sore throat when they have a Strep Infection.
They typically have uncharacteristic symptoms such as prolonged symptoms of nasal congestion and yellowish nasal discharge, low-grade fever, fussiness, decreased appetite, and tender neck glands.
Some may have redness around the anal opening which may be painful. They often have a history of exposure to older children with GAS pharyngitis.
Strep can be diagnosed via telemedicine or without testing:
Strep accounts for 15 to 30 percent of all cases of sore throat in children between the ages of 5 -15, so most cases are due to viral infections that don’t require antibiotic treatment.
Recent evidence suggests an increase in antibiotic prescription and use in those cared for via telemedicine.
Everyone with sore throat needs to be on antibiotics:
Confirmation of strep throat before initiation of antibiotic therapy helps to prevent the unnecessary use of antibiotics in children.
We recommend throat culture in those who have a negative rapid test if the index of suspicion is high.
Antibiotics are essential for treating bacterial infections like strep throat but can have their own risks.
Some risks include diarrhea, either due to the antibiotics or due to overgrowth of other bacteria that produce toxins, yeast infections, allergic reactions, and the development of antibiotic resistance. It is therefore essential to know when antibiotics are necessary for sore throat and when they are not.
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All children with a positive strep test and cold symptoms need to be treated with antibiotics:
It is best not to test for strep in children who have a cold or viral symptom such as a runny nose, cough, and mouth sores, because this may result in a false-positive test.
Note that 5- 21 percent of children between 3 -15 years of age are carriers of Strep. These children will test positive even when they have no symptoms.
Neither throat culture nor rapid test for Strep can differentiate patients with acute stre throat from Strep carriage with an intercurrent viral illness.
Such patients may fail to respond to antibiotic treatment for Strep infection. Clinical judgment may be needed in children who have underlying allergic rhinitis, chickenpox, or altered immunity.
Strep throat can be recurrent or persistent:
Persistent infection occurs when symptoms caused by Strep are not resolved after appropriate antibiotic treatment. This may be due to incomplete treatment or treatment failure.
Recurrent infection can be caused by the same Strep strain that caused the initial infection or by a different strain.
Recurrent infections most often occur among members of the same household or in other settings such as schools or daycare centers where close contact facilitates have Strep transmission.
Why is Strep Throat Treated?
Many children and adolescents with Strep throat will get better in a few days, even without antibiotic treatment.
Treatment is, however, recommended to speed up the resolution of symptoms and to decrease the risk of transmitting the infection to others.
Prompt treatment also decreases the risk of other complications resulting from an immune reaction to bacteria such as Acute Rheumatic Fever, kidney disease and neurologic disease with the acronym PANDAS (pediatric autoimmune neuropsychiatric disorder associated with group A streptococci).
Lastly, to decrease the remote risk of the bacteria being spread to other parts of the body or causing a local abscess (Peritonsillar Abscess).
Short delays in therapy while awaiting culture results have not been associated with increased rates of complications such as acute rheumatic fever.
What Antibiotics Work Best For Strep Throat?
Group A Strep is highly sensitive to penicillin. Most providers prescribe Amoxicillin for 10 days because it is more readily available and better tasting than oral penicillin. The course of antibiotics must be completed to decrease the possibility of treatment failure.
1 injection of long-acting penicillin (Bicillin LA) is an option for those suspected to be non-adherent or those who have potential problems with refrigeration (travelers, tourists, and indigent).
Most providers do not keep Bicillin in stock because it is expensive and infrequently used.
Alternative antibiotics will be used for those allergic to penicillin, travelers, or in those with persistent or recurrent infection.
Cephalosporins (Cephalexin, Cefdinir), clindamycin, and macrolides (Zithromax) are alternatives for patients who are allergic to penicillin or who cannot otherwise tolerate penicillin.
Your provider will provide guidance in these situations.
At Pediatrix Urgent Care, we can evaluate and determine the appropriate treatment for your loved ones with a sore throat at any of our 13 locations in Florida.
Dr. Ayodeji Otegbeye
About the Author:
Dr. Ayodeji Otegbeye, better known as “Dr. O” is the President and Founder of Central Florida Pediatrics Intensive Care Specialists and Night Lite Pediatrics Urgent Care. Dr. O was the Medical Director of Children’s Medical Services in the Central Florida Region (Orange, Seminole, Osceola and Brevard Counties) from 2004 – 2019; and the Medical Director of Leesburg Regional Hospital Pediatric Hospitalist Program.
Disclaimer: These articles are not intended to be used for diagnosis or treatment. It is aimed at presenting a perspective only and is not a substitute for a prescription. Anyone experiencing a medical condition should consult their doctor.