Sore Throat or Strep?

Fall weather is finally here across most of the country and with the new season, and school back in session, the first fall colds have hit.  I am already seeing a lot of runny noses and coughs, many of which are in the toddler and preschool set who still haven't learned to cover their mouths when coughing (don't worry, not yet age appropriate behavior, it takes some time to learn). 

With the common cold, or upper respiratory infection it is also not uncommon to have a sore throat.  Many parents worry that every sore throat is strep throat which is a bacterial infection.   A new article in the journal Clinical Infectious Disease published guidelines for doctors to help determine when it is appropriate to test for strep throat and use antibiotics when strep is confirmed. 

Studies have shown that up to 70% of patients who complained of a sore throat received antibiotics which are not necessary when the sore throat is due to a viral upper respiratory infection.  Strep throat is most common in children, where it accounts for between 20-30% of sore throats (and only 5-15% of adult sore throats). Strep is less common in children under the age of 3 years, and is most common during the elementary school years. 

Most viral upper respiratory infections cause runny nose, coughs, sore throat, hoarse voices and the symptoms develop over several days. In the case of strep, there is usually a rapid onset with a fever and cough and runny nose are not present. The child typically has very swollen and tender nodes in their neck as well. 

If a child is suspected of having strep throat a quick throat swab should be taken and a rapid strep test should be performed. These tests are performed in almost every doctors office. If the swab is negative for strep it may be sent for overnight culture as well.  Even the most seasoned doctor is not always correct in assuming a beefy red throat is strep.  If strep is confirmed an antibiotic, typically Amoxicillin is prescribed (unless the child is penicillin allergic). 

Antibiotic overuse for viral sore throats can lead to more drug resistance which continues to be a problem across the country.  With few new antibiotics in the pediatric pharmaceutical pipeline, it is important that doctors screen for strep only when the symptoms and physical exam point towards a bacterial cause for the sore throat.  It will be important to educate the parent and child as well, as not every sore throat requires a throat swab, and popsicles and Slurpees may soothe a sore throat and taste better than an unnecessary antibiotic. 

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