Why treat strep throat

There has never been a report of a clinical isolate of group A strep that is resistant to penicillin. However, resistance to azithromycin and clarithromycin is common in some communities. For patients with a penicillin allergy, recommended regimens include narrow-spectrum cephalosporins cephalexin, cefadroxil , clindamycin, azithromycin, and clarithromycin.

See the resources section for specific treatment guidelines for adult and pediatric patients 1,2,3. Abbreviation: Max, maximum. Clin Infect Dis. Note: If you are interested in reusing this table, first obtain permission from the journal; request by emailing journals.

Asymptomatic group A strep carriers usually do not require treatment. Carriers have positive throat cultures or are RADT positive, but do not have clinical symptoms or an immunologic response to group A strep antigens on laboratory testing. Compared to people with symptomatic pharyngitis, carriers are much less likely to transmit group A strep to others. Carriers are also very unlikely to develop suppurative or nonsuppurative complications. Some people with recurrent episodes of acute pharyngitis with evidence of group A strep by RADT or throat culture actually have recurrent episodes of viral pharyngitis with concurrent streptococcal carriage.

Repeated use of antibiotics among this subset of patients is unnecessary. However, identifying carriers clinically or by laboratory methods can be very difficult. The Infectious Diseases Society of America guidelines and Red Book address determining someone if is a carrier and their management.

Rarely, suppurative and nonsuppurative complications can occur after group A strep pharyngitis. Suppurative complications result from the spread of group A strep from the pharynx to adjacent structures. They can include:. Acute rheumatic fever is a nonsuppurative sequelae of group A strep pharyngitis. Post-streptococcal glomerulonephritis is a nonsuppurative sequelae of group A strep pharyngitis or skin infections.

These complications occur after the original infection resolves and involve sites distant to the initial group A strep infection site. They are thought to be the result of the immune response and not of direct group A strep infection. Good hand hygiene and respiratory etiquette can reduce the spread of all types of group A strep infection.

Hand hygiene is especially important after coughing and sneezing and before preparing foods or eating. Good respiratory etiquette involves covering your cough or sneeze. Treating an infected person with an antibiotic for at least 12 hours reduces their ability to transmit the bacteria. Per the American Academy of Pediatrics Red Book , people with group A strep pharyngitis should stay home from work, school, or daycare until:.

Humans are the only reservoir for group A strep. In the United States, group A strep pharyngitis is most common during the winter and spring.

CDC does not track the incidence of group A strep pharyngitis or other non-invasive group A strep infections. For information on the incidence of invasive group A strep infections, please visit the ABCs Surveillance Reports website. Strep throat is a bacterial infection in the throat and the tonsils. The throat gets irritated and inflamed , causing a sudden, severe sore throat. Strep throat is caused by streptococcal strep bacteria. There are many different types of strep bacteria. Some cause more serious illness than others.

Although some people are quick to think that any painful sore throat is strep, sore throats are usually caused by a viral infection and not strep bacteria. A sore throat caused by a virus can be just as painful as strep throat.

But if you have cold symptoms such as coughing, sneezing, or a runny or stuffy nose, you probably do not have strep throat. The most common symptoms of strep throat are:. You may also have a headache and belly pain. Less common symptoms are a red skin rash , vomiting, not feeling hungry, and body aches. Strep throat can be passed from person to person. When a person who has strep throat breathes, coughs, or sneezes, tiny droplets with the strep bacteria go into the air.

These droplets can be breathed in by other people. If you come into contact with strep, it will take 2 to 5 days before you start to have symptoms. Your doctor will do a physical examination, ask you about your symptoms and past health, and do a lab test such as a throat culture or rapid strep test. To do a throat culture, the doctor will swab a sample of cells from the back of your throat.

The sample will go into a special cup culture where the strep bacteria can grow over time. If strep bacteria grow, the doctor knows that you have strep. If the doctor does a rapid test and the test says that you don't have strep the test is negative but your symptoms suggest that you do, your doctor may want to do a throat culture to be sure. This is because rapid strep tests are not always accurate. If the rapid strep test is positive and says that you do have strep, there's no need to do the throat culture.

Doctors usually treat strep throat with antibiotics. Antibiotics shorten the time you are able to spread the disease to others are contagious and lower the risk of spreading the infection to other parts of your body.

Antibiotics also may help you feel better faster. You are contagious while you still have symptoms. Most people stop being contagious 24 hours after they start antibiotics. If you don't take antibiotics, you may be contagious for 2 to 3 weeks, even if your symptoms go away.

Your doctor may also advise you to take an over-the-counter medicine like acetaminophen such as Tylenol or ibuprofen such as Advil or Motrin to help with pain and lower your fever.

Acetaminophen and ibuprofen are different products with different dosing recommendations. Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine. Studies have not shown any added benefit from alternating these medicines.

Be safe with medicines. Read and follow all instructions on the label. Do not give aspirin to anyone younger than It has been linked to Reye syndrome, a serious illness.

To avoid getting strep throat, it is a good idea to avoid contact with anyone who has a strep infection. If you are around someone who has strep, wash your hands often. Don't drink from the same glass or use the same eating utensils. And don't share toothbrushes. Bacteria can live for a short time on doorknobs, water faucets, and other objects.

It's a good idea to wash your hands regularly. If you have a strep infection, there are things you can do to avoid spreading it to others. Use tissues you can throw away instead of handkerchiefs, wash your hands often, and do not sneeze or cough on others. Antibiotics can shorten the time that you are contagious.

It is a good idea to stay home from work or school until 24 hours after you have started antibiotics. Strep throat is caused by streptococcal strep bacteria, most often by group A beta-hemolytic streptococcus GABS.

Other types of strep that can sometimes infect the throat are groups C and G strep bacteria. A strep infection causes the throat pharynx and the tonsils or adenoids to become irritated, inflamed , and painful. Sore throats are most commonly caused by viral infections or other irritants such as smoke, allergies, dry air, or a throat injury, and not by a strep infection.

When a person infected with strep throat breathes, coughs, or sneezes, tiny droplets containing the strep bacteria are released into the air and are breathed in by other people. Common symptoms of strep throat in children and adults include:. In teenagers, mononucleosis can cause a severe sore throat that looks like and has symptoms similar to those of strep throat.

For more information, see the topic Mononucleosis Mono. It is easy to tell when you have a sore throat or a cold. It is harder to know when you have strep throat. Typically, sore throats are caused by a viral infection and not strep bacteria. Strep throat usually does not occur with cold symptoms such as coughing, sneezing, or a runny or stuffy nose. The more cold symptoms you have, the less likely it is that your sore throat is a strep infection. In some cases of strep infection, a skin rash develops and spreads over the neck and chest and eventually over the whole body.

The rash feels rough like sandpaper. This condition is called scarlet fever. Scarlet fever is treated with antibiotics. This usually leads to a quick recovery. Scarlet fever is not dangerous if treated. Symptoms of strep throat usually begin within 2 to 5 days after you come in contact with someone who has a strep infection. Strep throat usually goes away in 3 to 7 days with or without antibiotic treatment. In contrast, if allergies or irritants are the cause of your sore throat, it will usually last longer unless the cause is eliminated.

If strep throat isn't treated with antibiotics, you will continue to be contagious for 2 to 3 weeks even if your symptoms go away. You are much less contagious within 24 hours after you start antibiotics and are less likely to develop complications of the strep infection. Complications of strep throat are rare but can occur, especially if your throat infection isn't properly treated with antibiotics. Complications can occur when the strep infection spreads to other parts of the body and causes other infections, such as an ear or sinus infection or an abscess near the tonsils peritonsillar abscess.

Complications can also result in your immune system attacking itself and causing serious conditions such as rheumatic fever. Treating strep throat can greatly reduce your risk for rheumatic fever and its complications. It is not clear whether treating the strep infection with antibiotics reduces your risk for inflammation of the kidneys acute glomerulonephritis.

Your risk of getting strep throat increases if you come in close contact with others, especially children, who have a strep infection. The size of a child's tonsils isn't a risk factor for throat infections. Children or adults who have had their tonsils removed can still get strep throat. Call a doctor if the following symptoms develop 1 to 2 weeks or longer after a strep throat infection.

These symptoms may indicate rheumatic fever. Call your doctor if your symptoms do not improve after 2 days of treatment with an antibiotic. Watchful waiting is appropriate if your sore throat occurs with symptoms like those of a cold, such as sneezing, coughing, and a runny or stuffy nose.

In general, the more of these symptoms you have, the less likely it is that your sore throat is caused by a strep infection. You can try home treatment if your sore throat is not severe and you have other symptoms of a cold.

For more information on what to do if you have sore throat symptoms, see the topic Sore Throat and Other Throat Problems. Your family doctor or general practitioner can evaluate a sore throat, do throat cultures or quick tests, and prescribe antibiotic treatment if needed. You may be referred to a specialist, such as a pediatrician for your child, or an otolaryngologist ear, nose, and throat specialist.

If surgery to remove chronically enlarged or infected tonsils or adenoids is suggested, you may be referred to an otolaryngologist. Strep throat is diagnosed from your medical history, a physical examination of your throat, and a lab test, such as a throat culture.

Sometimes a rapid strep test is used to check for strep. Doctors have to be selective about testing for strep throat, says Shulman. Strep throat is not diagnosed just by symptoms: There are two tests used to confirm it.

The doctor or medical professional takes a throat swab, called a rapid strep test, or a throat culture. If the test comes back positive for the bacteria, then the doctor will usually prescribe an antibiotic.

But strep throat is a self-limited disease that will go away on its own, says Shulman. Antibiotics are not prescribed to treat strep itself, but to prevent serious complications, such as rheumatic fever. Narrow spectrum antibiotics, which the authors of the review recommend for treating certain cases of strep throat, are limited in the number of bacteria targeted and will not affect as many of the normal bacteria in the body.

The IDSA guidelines recommend narrow spectrum antibiotics such as penicillin. Amoxicillin is considered to be a broader spectrum antibiotic, so it will kill more bacteria than penicillin. Right now, total elimination of antibiotics for treatment of strep throat is not an option, because there are no real replacements.

But it is well worth considering alternatives, because there are other consequences of antibiotic overuse for people down the line, says Waldetoft. In the meantime, we wait for government agencies and pharmaceutical companies to develop alternative therapeutics.

By , it aims to develop new treatments through the enhancement of existing antibiotics and development of new antibiotic drugs.