Managing Strep throat in the era of antibiotic resistance

Strep throat is one of the most prevalent bacterial infections among children. It's estimated that every year about a quarter of school-aged children between 5 and 19 years get infected with strep throat. If you’re a parent, those numbers are no surprise to you. It seems like nearly every parent has dealt with Strep throat before either in their own childhood or with their kids. It peaks with the school year and colder weather, and spreads easily in schools and daycares.

Since Strep throat is due to bacteria, Streptococcus pyogenes, it can be treated with simple antibiotics. Although it can resolve on its own without medications, it’s important to start antibiotics as soon as you have a confirmed case. Waiting too long or forgoing antibiotics completely can lead to serious complications that can affect the heart and kidneys.

With most Strep throat infections, the symptoms usually start to markedly improve after three to four days, even without treatment. It’s still highly recommended to start antibiotic therapy as soon as possible because medication decreases the amount of time it takes for symptoms to improve. Symptoms generally start to improve after only one to two days once antibiotics have been started. 

Additionally, antibiotics are primarily given because they decrease the rate of Strep throat complications. One study showed that giving penicillin to strep throat patients reduced the rate of Rheumatic fever (a serious strep throat heart complication) by twofold. In addition to penicillin, cephalosporins (a family of antibiotics) can also be used to treat strep throat infection. Compared to penicillin, cephalosporins work faster than penicillin in terms of decreasing the severity of fever and sore throat that accompany Strep throat infection.

The studies that support treating Strep throat with antibiotics are numerous, however there is a growing counter argument against using antibiotics to treat Strep throat. Despite the body of evidence showing that antibiotics decrease the rate of complications, some argue that these complications might arise without showing symptoms of Strep throat to treat in the first place. For Rheumatic fever for example, some argue that roughly 60-75% of Rheumatic fever cases are preceded by sore throat and that antibiotic therapy will only prevent a few cases. 

Some reports estimate that the rate of Rheumatic fever due to strep throat has been in decline even before starting the routine practice of treating strep throat with antibiotics. Furthermore, most patients presenting with Strep throat symptoms actually have viral infections, and any Group A Strep organisms detected are because they are in fact carriers for Strep throat and have a low risk for strep throat complications. 

Additionally, using antibiotics on a large scale to treat Strep throat infections might lead to rare but rather serious complications like anaphylaxis, which is a severe allergic reaction to antibiotics. Increasing the use of antibiotics to treat Strep throat infections also increases the risk of antibiotic resistance. For example, the number of Group A Strep bacteria that macrolides (a family of antibiotics) are effective against is declining in countries with high use of macrolides to treat Strep throat infections.

Most children have an episode of sore throat annually. Most of these are due to viruses. And the use of antibiotics should be only for proven Strep throat infections to prevent the occurrence of serious complications such as Rheumatic heart disease. 

With all that being said, we feel the best course of action is to first confirm that your child’s sore throat is actually strep. Once you’ve got a diagnosis in hand, you and your pediatrician can determine the best course of action, whether that’s to start antibiotics or simply manage symptoms in the case of a negative Strep test. 

With the ability to rapid test at home, you can test for Strep from the comfort of your home, then work with a doctor to determine the next best steps for everyone. Checkable Medical is your source for reliable at-home rapid Strep tests so you can test, treat and get on with your life.