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IDSA Issues Revised Strep Throat Guidelines

New recommendations promote appropriate use of antibiotics (Sept. 10)

Although people often say they have “strep” throat, most sore throats actually are caused by a virus, not streptococcus bacteria, and shouldn’t be treated with antibiotics, suggest guidelines published by the Infectious Diseases Society of America (IDSA). Antibiotics are ineffective against viruses.

The IDSA’s newly revised guidelines for group A streptococcal pharyngitis &mdasj; strep throat — also advise that when a strep infection is confirmed by testing, it should be treated with penicillin or amoxicillin — if the patient does not have an allergy — and not azithromycin or a cephalosporin. Further, the guidelines recommend that children who suffer from recurrent strep throat should not have their tonsils surgically removed solely to reduce the frequency of infection.

The guidelines were published on September 10 in Clinical Infectious Diseases.

About 15 million people in the U.S. see a physician for a sore throat every year, and up to 70% receive antibiotics, although only a smaller percentage of these patients actually have strep throat: approximately 20% to 30% of children and 5% to 15% of adults.

The guidelines note 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-listed features — but the diagnosis should be confirmed through testing before antibiotics are prescribed, the guidelines note.

If strep is suspected, the guidelines recommend that 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. Results of the culture can take up to several days, but antibiotics should not be prescribed unless the results are positive, the guidelines note. Because strep throat is uncommon in children aged 3 years or younger, they don’t need to be tested, the guidelines recommend.

“The guidelines promote accurate diagnosis and treatment, particularly in avoiding the inappropriate use of antibiotics, which contributes to drug-resistant bacteria,” said lead author Stanford T. Shulman, MD. “We recommend penicillin or amoxicillin for treating strep because they are very effective and safe in those who are not allergic, and there is increasing resistance of strep to the broader-spectrum — and more expensive — macrolides, including azithromycin.”

For more information, visit the IDSA Web site.

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