Kids' Strep Throat: Likely No Need to Lose Tonsils
New Guidelines Also Say Antibiotics Widely Overprescribed for Sore Throat
Sept. 12, 2012 -- New guidelines highlight two key recommendations about strep throat: Recurring cases should not necessarily lead to having tonsils removed. And overdiagnosis of strep needs to be reined in, because it's a major contributor to antibiotic overuse and resistance in the U.S.
In the new guidelines released this week, the Infectious Disease Society of America (IDSA) called on doctors to be selective about who they test for strep throat, and to confirm a suspected diagnosis before prescribing antibiotics.
The doctors group also recommends against removing a child's tonsils just because they've had multiple cases of strep over the course of one year.
Americans make about 15 million doctor visits for sore throats each year. But only a small percentage of these patients actually have strep throat, a bacterial infection that responds to treatment with antibiotics.
The rest -- as many as 80% of children and 95% of adults -- have sore throats caused by viral infections (such as the common cold) that are not helped by the drugs.
Cough and Runny Nose? It’s Not Strep
The guidelines state that people with obvious cold symptoms such as runny nose, cough, hoarseness, and mouth sores, do not need to be tested for strep throat.
A sore throat that comes on suddenly with fever, but without these cold symptoms, is far more likely to be strep.
When strep throat is suspected, the diagnosis can often be confirmed in just a few minutes with a rapid strep test.
If the rapid strep test doesn’t confirm a strep infection, a throat culture is recommended for children over the age of 3 and for teens, but not for most adults. (The culture involves another swab of the throat that is sent to the lab to see if strep bacteria grow. This test takes longer for results.)
There is almost no risk that strep throat in very young children and adults will lead to rheumatic fever, an increasingly rare but potentially deadly complication.
Although the rheumatic fever risk is small in older children and teens, it is still important to identify and treat strep throat in this age group to lower the risk even further, says researcher Stanford T. Shulman, MD, chief of the division of infectious disease at Ann & Robert H. Lurie Children’s Hospital of Chicago.