Watch Your Strep With a Sore Throat

Most sore throats brought on by a virus rather than the bacteria that causes strep

/ Author:  / Reviewed by: Chris Galloway, M.D.

(RxWiki News) About 15 million people in the US see a doctor annually for a sore throat. Many are misdiagnosed with strep, and up to 70 percent are given antibiotics that will not fight a virus.

New guidelines for Group A streptococcal throat infection were published by the Infectious Diseases Society of Americas. They suggest that most throat infections are not caused by strep, but by viruses. So most sore throat patients don't need antibiotics.

"Get a proper diagnosis for sore throat."

Stanford T. Shulman, MD, chief of the division of infectious diseases at Ann & Robert H. Lurie Children's Hospital of Chicago and professor of pediatrics at Northwestern University Fineberg School of Medicine in Chicago, served as lead author for these guidelines.

He and his fellow researchers noted that a sore throat is more likely to be a viral throat infection if the symptoms are a cough, runny nose, hoarseness and mouth sores.

The guidelines advise that adults and children do not need to be tested for strep if they have these symptoms.

A strep patient, on the other hand, may experience sudden pain, difficulty swallowing and a fever without the symptoms of a viral sore throat.

If strep throat is suspected, Shulman and his team recommended doctors use the rapid antigen detection test, often called the rapid strep test.

To perform the test, a doctor quickly rubs a cotton swab over the tonsils and back wall of the mouth. The swab is then placed in a solution, which provides results in 10 to 15 minutes.

If a strep infection is confirmed by testing, the guidelines advocate treatment with the antibiotics penicillin or amoxicillin, as long as the patient does not have an allergy. The scientists do not advise taking azithromycin or a cephalosporin.

"We recommend penicillin or amoxicillin for treating strep because they are very effective and safe in those who are not allergic,” said Dr. Shulman, “and there is increasing resistance of strep to the broader-spectrum—and more expensive—macrolides (a group of antibiotics), including azithromycin [and cephalosporin]."

If the rapid strep test is negative, a follow-up throat culture is recommended for children and adolescents, but not for adults.

Results of the culture can take up to several days. Guideline authors say that antibiotics should not be prescribed unless results are positive.

Because strep throat is uncommon in children three years old or younger, they don't need to be tested, according to the report.

Dr. Shulman adds that the guidelines recommend against performing a tonsillectomy for children with repeated throat infection in most cases because the risks of surgery are generally not worth the temporary benefit.

Untreated strep throat can increase a patient's risk of developing scarlet or rheumatic fever, as well as diseases affecting the heart, skin, kidneys and joints.

While serious complications such as these have declined in the US, they do occur, says Dr. Shulman. So accurate diagnosis is vital.

These guidelines were established by an eight-member panel of experts, including adult and pediatric infectious diseases doctors, pediatricians and respiratory diseases authorities.

The guidelines are intended to support the doctor’s decision-making process. Diagnosis and treatment must be determined on a patient-to-patient basis, according to each individual’s circumstances.

The guidelines were published in September in the journal Clinical Infectious Diseases.

Reviewed by: 
Review Date: 
September 27, 2012
Last Updated:
July 8, 2013