Sore Throat
MOST
sore throats are not Strep.
They are caused by viruses and will resolve without treatment.
Strep is a bacterium which causes about 20% of sore throat in children.
This actually fluctuates between 5-50% from time-to-time and
community-to-community; we will always know approximately how common it is at
this moment in your community.
Despite the fact that it’s bacterial, Strep
also usually gets better by itself, even without antibiotic treatment!
Antibiotics may make the symptoms resolve a little bit faster, but this
is marginal - e.g. they may shorten the illness from 5 days to 4, and only if
started early. The real reason we treat Strep
is not to make it go away, but rather to prevent
later complications of the disease such as
Rheumatic Fever.
This and other "post-Strep syndromes" can occur up to months
after an untreated case and can be devastating.
Antibiotics prevent this as long as they are given within 2 weeks of the
illness. In
fact, some evidence indicates prevention may be more effective when treatment is
delayed several days rather than started right away!
It
is impossible to tell who has strep just by looking.
Nothing about the appearance of the child or their throat correlates -
not fever, size of tonsils, swollen glands, white patchs - all of these things
can happen with both strep or viruses, any or all of them can be absent with
either as well.
Therefore, usually ANY sore throat should be
tested for Strep.
There is no urgency to doing this
- anytime within several days of the onset of symptoms is fine.
The only exception to this rule may be certain times of the year during
epidemics of certain viral sore throats which do have a characteristic
appearance, and can be diagnosed with certainty (such as Coxsackie in the
summertime). In
our office we will do a "rapid strep test" and treat immediately if
it's positive. Since
rapid strep tests are only about 90% accurate, in most cases we will send off an
actual culture (results take 24-72 hours) if the rapid test is negative.
You will be called ONLY if it turns out to
be positive, and an antibiotic will then be
prescribed. No
antibiotic is necessary if both rapid test and culture are negative.
Sore
throats should be cared for with Acetaminophen or Ibuprofen, a bland diet, and
plenty of liquids (milk, soup, or ice cream may be better than juice as acid in
the latter may exacerbate pain). If
a child is old enough salt water gargles and/or anesthetic sprays and lozenges (Chloraseptic,
Sucrets, many other brands) may be of some benefit.
Danger signs (rare) with a sore
throat include:
marked
difficulty swallowing
(with
drooling and inability to take even liquid in - not just pain with solid food),
loss of voice
difficulty breathing
substantial asymmetry
(difference in tonsil size between the two sides).
Call
immediately
should any of these occur.
Finally, as noted above most sore throats (even Strep) get better
themselves, usually within a week.
A sore throat which persists longer than
this may be "Mono" or may be a sign of other underlying problems.
Please call for a persisting sore throat so that these possibilities may
be investigated.
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