Guidelines recommend judicious use of testing, antibiotics, children's tonsillectomies for strep

Most sore throats are caused by a virus, not streptococcus bacteria, and shouldn't be treated with antibiotics, suggest guidelines published this week by the Infectious Diseases Society of America (IDSA).

The IDSA's newly revised guidelines for group A streptococcal pharyngitis also advise that when a strep infection is confirmed by testing, it should be treated with penicillin or amoxicillin in nonallergic patients and not an antibiotic such as a cephalosporin.

Penicillin and amoxicillin are very effective and safe in those without allergies, and there is increasing resistance of strep to the broader-spectrum and more expensive macrolides, including azithromycin, said the study's lead author in a press release.

The guidelines were published in Clinical Infectious Diseases.

The guidelines noted that children and adults do not need to be tested for strep throat if they have a cough, runny nose, hoarseness and mouth sores, which are strong signs of a viral throat infection. A sore throat is more likely to be caused by strep if the pain comes on suddenly, swallowing hurts and the patient has a fever without the above features, but strep should be confirmed through testing before antibiotics are prescribed, the guidelines noted.

If strep is suspected, the guidelines recommend physicians use the rapid antigen detection test, which provides results in a few minutes. If that test is negative, a follow-up throat culture is recommended for children and adolescents, but not for adults. Although results of the culture can take up to several days, antibiotics should not be prescribed unless results are positive, the guidelines note. Because strep throat is uncommon in children three years old or younger, they don't need to be tested, the guidelines recommend.

Also, the guidelines recommend against tonsillectomy for children with repeated throat infection except in very specific cases, such as a child who has obstructive breathing, because the risks of surgery are generally not worth the transient benefit, the lead author stated. Serious complications from strep throat, particularly rheumatic fever, have diminished in the United States but occasionally do occur, so accurate diagnosis is key, he said.