Should You Worry About Strep Throat

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Twice in as many months, your child complains of a sore throat and trouble swallowing. You have her open her mouth, and say “ahh,” and there are those little white dots in the back of her throat. You wonder, is it the strep throat? Again?

Strep throat (streptococcal pharyngitis) is one of the most common bacterial infections of childhood. Tiny egg-shaped bacteria called Group A streptococci cause the infection. The classic signs of strep include fever, swollen lymph nodes and tonsils and a red throat that may have little white or yellow pus spots (called “exudate”).

“It”s not unusual for children to get (recurrent) strep throats,” says Dr. Keith Krasinski, professor of Pediatrics and professor of Environmental Medicine at New York University Medical School. Krasinski is also a board-certified pediatrician in infectious diseases.

School age children are highly susceptible to strep, as they are to other highly contagious infections, such as cold viruses or the flu, Krasinski says. They play together, often don”t have the best hand-washing hygiene, and therefore they spread and catch germs easily.

Identifying strep throat

He says the only sure way to know your child has strep is to visit a doctor and have a throat culture taken, Krasinski says. Some of the symptoms of strep throat, such as a sore throat and fever, are often symptoms of other infections, such as a cold or flu, which makes it impossible to diagnose a strep infection based on a physical examination alone, he notes.

The incubation period of strep is about three to five days. Standard cultures can take several days, however, so often doctors make a tentative diagnosis based on their observations and begin treatment with antibiotics pending the results of cultures, according to Tom Egan, PharmD, executive director of the Office of Professional Programs and clinical associate professor of Health Policy at the University of Sciences in Philadelphia.

“Half the people who are treated for strep don”t have it,” says Egan, which adds to the problem of antibiotic resistance.

Krasinski says that is why people should not let their doctor just dispense antibiotics when they show up with a sore throat. If the doctor is reasonably sure it looks like strep, then have that confirmed through a bacterial culture, he says.

Potential complications

If it is strep, a patient does need to be treated because of the danger of complications and rheumatic fever, and because he or she will less likely become a carrier for the strep bacteria), Egan says. Strep may trigger autoimmune reactions, where the immune system attacks the bacteria and then goes on to attack the body”s own tissues. Rheumatic fever, which is one such reaction, can cause permanent damage to the valves of the heart.

“The risk of rheumatic fever is actually low because lots of people get antibiotics for lots of different things,” Egan says.

Krasinski adds that the information about the risk for rheumatic fever came out of studies in adult military recruits many years ago and has never been replicated in children. Still, doctors do not dismiss the risk because of the serious medical repercussions.

“Recurrences of strep throat by themselves shouldn”t be particularly worrisome,” Krasinski says. If they do occur, the questions are, did the child take the full course of antibiotic needed to kill the strep, and is the child being exposed to a chronic carrier? Chronic carriers of strep, who may be a parent himself or another child at school, carry streptococci around in their bodies, even when they aren’t sick.

Current antibiotic therapy

Penicillin is the standard therapeutic treatment for strep infections. The oral antibiotic is given for 10 days. Taking less than a 10-day course may not be enough to kill the strep. If a parent has difficulty getting a child to take the daily dose, then the doctor may chose to administer an intermuscular injection of benzethene penicillin, according to Krasinski. The one shot is good for the 10 days.

Erythromycin is often prescribed for those allergic to penicillin, although it”s not as effective as penicillin, Krasinski says, and often upsets the stomach. Cephalosporins, amoxicillin-clavulinate and clindamycin are also used to kill strep.

“Authorities differ about which ones to use,” Krasinski says. Cephalosporins have greater eradication rates than penicillins, although the newer ones are more expensive. Clindamycin has been shown to be particularly useful in treating chronic carriers of the strep bacteria.

How long should you keep a child with a strep throat out of school? Certainly until he or she is feeling better. However, Krasinski says antibiotics are potent defenses against an army of strep bacteria. An antibiotic can suppress group A strep within 24 hours after it is begun.

Strep at a Glance

  • Strep A infection accounts for 20 to 40 percent
    of all cases of pharyngitis (sore throats) in children
  • Incubation period is 3-5 days
  • Symptoms go away in 3-5 days, however if untreated
    it can cause autoimmune reactions, such as rheumatic fever.
    Rheumatic fever is rare, but dangerous.
  • A throat culture is the only way to diagnose if it”s strep
  • Penicillen, or other antibiotics, kill strep
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