The Mysteries of Streptococcal Pharyngitis.

Abstract

Streptococcal pharyngitis is common in children between 5 and 15 years of age. While there is a “classic” presentation, few patients have all of the characteristic signs and symptoms. Therefore, for those children who present with a sore throat in the absence of other respiratory symptoms such as nasal congestion and cough, the best method of determining the etiology of the illness is to obtain a swab of the tonsils and posterior pharynx and to test it for the presence of Group A Streptococci (GAS). Performing this testing, allows the clinician to safely avoid the use of antibiotics in children who do not test positive for this pathogen. These children are more likely to have a viral cause for their illness. Conversely, those who test positive for GAS can be offered antibiotics, such as penicillin or amoxicillin for treatment. Administering antimicrobial therapy will lead to more rapid clinical improvement and will decrease person to person transmission. In addition, it will prevent suppurative and some non-suppurative complications such as rheumatic fever. Some patients will have multiple episodes of illness during one school year associated with a positive test for GAS. This either represents true recurrent GAS infections or recurrent viral illnesses in children who have become streptococcal carriers. There are strategies to assist with the clinical management of both of these groups of children.