‘To Swab or Not to Swab?’ What is Strep Throat and when should you bring your child to the doctor?

Doctor checks little girl for strep throat.

A sore throat is a common complaint in pediatrics. But how common is strep throat? Group A Strep is the most common cause of bacterial pharyngitis (sore throat) in children and adolescents. Although common, it only causes about 15-30% of all cases of pharyngitis in ages 5-15 years. This means that viruses such as Ebstein Barr, Adenovirus, Influenza, and Enterovirus cause most sore throats out there! The peak is typically winter and early spring, but as a pediatrician I am on the lookout for strep pharyngitis all year.

Strep pharyngitis starts with symptoms that can include abrupt fever, headache, abdominal pain, nausea, vomiting, and rash. Most of the time viral symptoms such as runny nose, cough, hoarse voice, and diarrhea are absent. Symptoms can resolve without treatment in 3-5 days, but pediatricians treat strep pharyngitis to avoid complications that carry long-term implications for our patients such as rheumatic fever, post strep kidney disease, skin infections and blood infections.

We diagnose strep by a rapid strep test (swabbing the back of the throat- ouch!) in children without significant viral symptoms. If a child is negative on the rapid swab, we will send for culture. We do not make our decision to treat initially based on culture although it is more accurate because it takes 48-72 hours to come back. This means that the rapid strep test is a great quick test but will miss some cases of strep. I always say when in doubt send for culture our ‘double’ check.

If positive on the rapid strep test, then your doctor will send in an antibiotic for 10 days. A patient is usually not contagious after 24 hours. The goal of treatment is to reduce symptoms severity and
duration, prevent complications, and prevent spread. We usually do not send in antibiotics for negative rapid tests unless we have a compelling reason such as multiple positive siblings. I do understand it is hard to wait for the culture to be back- but antibiotics do not come without risk! Data has shown that short delays awaiting culture have not been associated with increased complications.

The treatment of choice is penicillin (Amoxicillin). Symptoms will improve after 24 hours, but 10 days of treatment have been shown to completely eradicate group A strep from the throat. There are many other alternatives for penicillin for allergic patients. Besides a trip to the local pharmacy to pick up your medicine I would suggest supportive care such as rest, fluids, and Ibuprofen/Tylenol for pain control. Tonsillectomy is rarely indicated for recurrent strep.

As always, the easiest method is not to get sick at all- Prevention such as hand hygiene and not sharing drinks goes a long way.

Hopefully, you now have a better understanding of when you should bring your child into the office for a throat swab!

Mother with sick child and thermometer

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