Sore Throats Mostly Viral, Not Strep

Health Care, Medicine Comments Off
  • Most throat infections are viral and should not be treated with antibiotics, according to new guidelines from the Infectious Diseases Society of America, reports Medscape in the journal Clinical Infectious Diseases.
  • 70% of Americans with a sore throat receive antibiotics. However, bacteria are responsible for only 20% to 30% of pediatric cases and 5% to 15% of adult cases.
  • Although bacterial and viral throat infections often have overlapping symptoms, other symptoms, such as cough, rhinorrhea, hoarseness, and oral ulcers, strongly suggest a viral infection.
  • A sore throat is more likely to be caused by group A strep if the onset of pain is sudden, swallowing hurts, and a fever is present. Such cases can be evaluated using a stand-alone rapid antigen detection test. Because children younger than 3 years are unlikely to have strep throat, testing is unnecessary, with the exception of certain circumstances such as an infected older sibling.
  • Throat cultures should only be used to confirm negative antigen tests in children and adolescents.
  • They should be eschewed in adults because of their low risk for strep throat and even lower risk for complications such as rheumatic fever.
  • Once strep throat is confirmed, the treatment of choice remains a 10-day course of penicillin (or its congener amoxicillin), which has a narrow spectrum of activity, is cheaply available, and carries a low risk for adverse events.
  • Penicillin or amoxicillin is the choice for treating strep because they are very effective and safe in those without penicillin allergy, and there is increasing resistance of strep to the broader-spectrum — and more expensive — macrolides, including azithromycin.
  • The guidelines also recommend against tonsillectomy for children with repeated throat infection, except in very specific cases (e.g., children with obstructive breathing), because the risks of surgery are generally not worth the transient benefit.