For decades, family doctors and pediatricians prescribed antibiotics for group A streptococcus (GAS) pharyngitis – or strep throat – not because of the irritation and discomfort caused by the resulting soreness and fever, but because of the potentially fatal threat of Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease, a relationship that was discovered more than 70 years ago in the midst of World War II.
But, oh, the times, they are a-changing.
Today, instances of Acute Rheumatic Fever in the United States – which once served as the impetus for the swift administration of antibiotics – are increasingly rare. Meanwhile, concerns regarding overtreatment and the inadvertent development of resistant bacteria should cause physicians and pediatricians to rethink reaching for their Rx pad.
After all, the majority of sore throats and related sniffles – approximately 70-80 percent in children – are caused by viral illnesses, and absolutely nothing can change that other than time and TLC.
Strep is also self-limiting. Although recent schools of thought have expressed that an immediate course of antibiotics will eliminate the threat of contagion after 24 hours, the illness itself typically runs its course within a week’s time.
Additionally, many people – adults and children, alike – are simply carriers of the streptococcus bacteria. Although they never pass it to others, a visit to the doctor’s office due to a sore throat often leads to a strep test, and a false positive. Frequently prescribed antibiotics, such as amoxicillin, can do more harm than good – contributing to the aforementioned resistance, eliminating beneficial gut bacteria, and even causing severe allergic reactions.
While strep is far more common in children, it is a rare occurrence in children under 3. The illness presents itself most commonly in children ages 5-15 during the winter and spring. For these reasons, particularly in the very young, testing is not recommended when viral causes are strongly suspected.
Because strep throat is relatively common, recognizable, and easily detected via rapid tests and throat cultures, clinical diagnoses and an open, honest dialogue with patients, parents, and guardians is critical in mitigating the overuse of antibiotics.
So, “When should I worry?” The telltale signs of strep throat include:
- Pharyngitis (sore throat) with sudden onset
- Pain and discomfort while swallowing
- Red and swollen tonsils, occasionally accompanied by white patches or pus
- Tiny, red spots on the soft or hard palate
- Swollen lymph nodes
- Nausea – particularly in children
The painful truth? If sudden pharyngitis is not present; if fever and redness are not detected; and if a patient merely has cold symptoms such as a runny nose, cough, and general irritation – testing and treating for strep are discouraged.
Sore throats are a nuisance, though. In lieu of antibiotics, consider the following options:
- Ask about over-the-counter options that may help alleviate symptoms.
- Encourage fluids.
- Try a saline nasal spray to relieve congestion.
- Soothe throats with crushed ice, lozenges (for older children), sprays, and honey (for ages 2 and older).
With the school year just starting, parents and guardians will undoubtedly be on high alert for common school year contagions including strep throat. If you’re one of the many wondering “when should I worry,” the specialists at KinderMender can help to put your mind at ease, while making an accurate diagnosis. Our presiding goal is healthy happy families. Visit one of our four convenient Maryland locations whenever you are in need.