SAN DIEGO– If a child presents with what looks like recurrent strep throat, physicians should ask two questions before prescribing antibiotics: Is this a true recurrence of strep infection? And if so, was the child treated adequately the first time?
Viral pharyngitis is in fact the most common cause of what looks like recurrent strep throat, Dr. John Bradley said at the annual meeting of the American Association of Pediatrics. Rapid strep tests can detect very low levels of streptococcus organisms in children who are carriers, so “it can look like a recurrent strep infection when it’s really a virus” that is causing a sore throat, he added.
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Physicians should ask whether the patient has the same amount of exudate present at “recurrence” as during the initial infection, said Dr. Bradley, who is a pediatric infectious diseases specialist at the University of California, San Diego. If not, they should order an antistreptolysin O (ASO) titer to prove that there is current streptococcal infection, while keeping in mind that the titer takes 2-3 weeks to increase, he said.
If the infection truly is recurrent strep, amoxicillin may be a better choice than penicillin V because of its superior absorption and tolerability, Dr. Bradley said. Amoxicillin has a longer half-life, better tissue exposure, and also tastes better than penicillin V, which leads to better compliance, he said.
Doctors should base the dose of amoxicillin on the severity of the child’s illness, Dr. Bradley added. Based on his experience, he recommends amoxicillin at a dose of 75 mg/kg three times a day if the affected child has abscessing tonsillitis, even though 40 mg/kg per day may work, he noted.
“Some kids have abscess-riddled tonsils that are so painful that they can’t swallow,” Dr. Bradley emphasized. “The idea that one dose fits everyone breaks down when you have bad strep throat.”
Dr. Bradley reported no conflicts of interest.