The Enid News and Eagle, Enid, OK

November 20, 2013

Know strep throat basics

By Judy Rupp, columnist
Enid News and Eagle

— Strep throat: it sounds so bad, as if the throat has been “strepped” (whatever that means) by some nasty bug. Confronted with a child who complains of a sore throat, most parents make a quick trip to the doctor to see if it’s strep throat.

Strep is short for Group A Streptococcus bacteria, the organisms responsible for 20 to 30 percent of sore throats among children aged 5 to 15, and 5 to 15 percent of those in adults. Strep throat is dangerous because, untreated — it can lead to serious complications such as rheumatic fever and inflammation of the kidneys, which can cause kidney failure. But it’s not as common as most parents think.

The most frequent cause of a sore throat is a viral infection, usually related to a cold. If the patient has a runny nose, stuffed nasal passages, coughing, sneezing and hoarse voice, it’s very unlikely that the problem is strep throat, and there is probably no reason to visit the doctor unless symptoms get worse. Antibiotics will not help.

If you have had strep throat yourself, you probably know the signs: sore throat, usually appearing quickly; pain when you swallow; fever over 101 degrees Fahrenheit; swollen tonsils and lymph nodes; and a bright red throat with white or yellow spots.

When these symptoms are present, a visit to a doctor is recommended, and it’s tempting for the physician to make a diagnosis on the basis of suspicion and prescribe antibiotics. Parents usually expect it, and there is no question that this is often done. Studies show that 70 percent of sore throats are treated with antibiotics whereas only about a third of these can be expected to be caused by Group A Streptococcus. This practice is not recommended, however, by treatment guidelines of the Infectious Diseases Society of America.

Overuse and misuse of antibiotics leads to the development of antibiotic-resistant bacterial strains that can reduce the patient’s own later immunity and put seriously ill persons at risk of illness that gets out of control. The 2012 update to treatment guidelines strongly stresses the need to confirm a diagnosis and not rely on clinical suspicion.

The gold standard for confirming a diagnosis is a throat culture, rubbing a sterile swab over the back of the throat and the tonsils. While not painful, this can be uncomfortable and treatment may be delayed as long as two days while the culture is grown and tested.

The rapid antigen test can detect strep bacteria within minutes but may miss some infections. If results are negative, many doctors rely on the throat culture as a backup for confirmation — but only for some patients.  These tests are not usually recommended for children younger than 3 since strep infections are rare in this age group, nor for adults since they have a low risk of serious complications.

For patients with a confirmed Streptococcus infection and a risk of complications, guidelines call for use of antibiotics — usually a 10-day course of either penicillin V or amoxicillin. For persons with no allergies to them, these medications are inexpensive, safe and effective. Increasing resistance to strep has been found in some of the more expensive, broader spectrum antibiotics.

It’s crucial that the patient take the full course of antibiotics, even after the symptoms get better. Failure to complete the course might lead to recurrence and yet another risk of antibiotic resistance.

In addition to making you feel better sooner, antibiotics also shorten the time you are contagious. You start being contagious even before symptoms appear, and continue to be so for the first 24 hours after antibiotic therapy is started.

You’ll also feel better through use of over-the-counter medications such as ibuprofen (Advil, Motrin) and acetaminophen (Tylenol). Aspirin should not be given to anyone under age 18 because of the risk of Reye syndrome.

As with all infections, the best way to protect yourself and others is to wash your hands frequently, cover your mouth when you cough or sneeze and avoid sharing food, glasses and utensils.  

General recommendations include throwing away the patient’s toothbrush once antibiotics have been started. On the other hand, a recent study found that while common mouth bacteria grew on all of the toothbrushes studied, strep could be found only on the brush of a child who did not have strep but was undoubtedly a carrier.

Many children and even some adults carry a colony of Group A Streptococcus bacteria in their throats without becoming sick. These carriers do not have strep throat and should not be prescribed  antibiotics, according to guidelines, since they are unlikely to be infectious or develop complications.

Decisions regarding strep throat and its treatment revolve mainly around the potential risk of complications rather than the sore throat.

Rupp is a certified information and referral specialist on aging for NODA Area Agency on Aging. Contact her at 237-2236.