Sore Throat

By Frank Fanella, MD

Lots of parents wonder what to do when their child has a sore throat. Should the child be on antibiotics? Is it  er, an old illness that has made a comeback in recent years, might be the result of a different strain of bacteria, or genetics. Whatever the cause, it is most likely preventable but antibiotics must be started within a week of onset of the illness.

Rheumatic fever is the diagnosis if you have a history of strep in the past few months and when two of the five following symptoms result: a specific rash, migrating arthritis, significant neurological sequelae such as involuntary movement of extremities, nodules under the skin, and inflammation of the heart. The major reason to treat strep is to prevent rheumatic fever. Studies done in the past proved the necessity of treating strep and doctors have been prescribing antibiotics for it ever since.

Once you’ve made the decision to go to the doctor for a strep throat culture, there are still a few things to consider. Many physicians’ offices offer the rapid strep test. This can be done right in the doctor’s office in a matter of five minutes. If that is positive, then it’s fairly certain that the child really has strep and antibiotics are ordered immediately. If the doctor thinks that it really looks like strep, but the test is negative, then a lab culture might be ordered. This takes two or three days, but it’s the “gold standard” in strep tests. If the test result is negative, then the illness definitely is not strep. If the doctor suspects strep, he might begin treatment while waiting for the lab results.

The choice of antibiotic for strep is fairly routine. Even though a child’s ear infection may not respond well to Amoxicillin, strep is always responsive to this antibiotic. Penicillin or Amoxicillin  is generally the drug of choice for strep. It is important to confirm the diagnosis since other illnesses, such as mononucleosis, mimic these symptoms. Strep is easy to treat and a full recovery is expected with treatment. There is no need for children to suffer the consequences of rheumatic fever when rapid strep tests, lab tests and antibiotics are readily available. The biggest problem is knowing when to follow through and have a throat culture done. Generally, when the sore throat is accompanied by a runny nose and cough it is usually due to viral infection. If there is a fever and sore throat, and it goes on for several days, then it might be a good idea to test for strep. Be sure your child finishes the prescription even though he or she feels just fine two days later. Strep throat can have serious consequences, but our antibiotics and lab technology mean that no child needs to suffer needlessly.

Dr Fanella of New Milford is a pediatrician with Candlewood Valley Pediatrics at 28 Old Park Lane, New Milford. He is on the staff of New Milford Hospital.