Ask the Pediatrician | Illness

Strep throat needs proper diagnosis and treatment

Fever, sore throat, headache, stomach ache, and rash are the hallmark symptoms of strep throat. You may not have all of them but if you have a couple it’s a good idea to get checked out.

When I was a young doc 20-plus years ago, diagnosing strep throat for seasoned doctors involved nothing more than looking at a sick child’s throat and if you were uncertain getting a throat culture that took 2 days to give a definitive answer. Doctors would go on the look of the throat and the conglomeration of other symptoms and often would treat or not without ever doing a test.

As time passed, rapid strep tests done in the office came on the scene and making a more accurate diagnosis got easier. It turns out that our eyes aren’t really all that good at predicting which red throats are actually infected with strep, so doing a test is important whenever the clinical picture puts strep on the list of possibilities.

I get a bit frustrated with my adult medicine colleagues and urgent care providers because often no test is done but parents are put on antibiotics for presumed strep throat and then when their child gets sick and my test is negative it’s hard to explain why I’m not going to treat their child. Bottom line is that a test is always a good idea.

Another study recently also pointed out the importance of proper treatment when it comes to strep. Penicillin drugs are best, amoxicillin being the most common and best tasting of that class, but for kids who are allergic to penicillins, the newest data suggests azithromycin (Zithromax or a Z pack) is a risky choice. In some areas of the country up to half the time this drug failed to work well enough and an increase in cases of Rheumatic fever have been seen in children treated with zithromax.

Rheumatic fever is a serious illness that typically follows an untreated (or inappropriately treated) strep infection. It can cause arthritis, movement disorders, and serious heart problems. It is one of the main reasons we treat strep rather than just letting the body get over it on its own. Most of the time untreated strep will resolve without antibiotics, but the complications can be serious.

For children and adults allergic to penicillin, the best choice is a version of erythromycin or a cephalosporin-like cephalexin (Keflex), not azithromycin. It’s too bad, though, because the better options for the allergic child taste yucky and have to be taken for 10 days. Zithromax was appealing because it is only given for 5 days and isn’t horrible tasting. Unfortunately, the risk of Rheumatic fever is too high so it should really be off the list for consideration now.

Dr. Molly O'Shea
Dr. Molly O'Shea is a board-certified pediatrician who cares for families in her practice Birmingham Pediatrics + Wellness Center. She will answer your questions on babies, children, adolescents and families and address common concerns.