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You have just diagnosed an afebrile 10-year-old child who presented with sore throat, pharyngeal erythema and exudate, and tender lymphadenopathy with rapid-test-positive Group A streptococcal pharyngitis.
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October 2, 2024 at 3:08 am
C) She may return to school after she has taken 24 hours of antibiotics
Pharyngitis confirmed to be caused by Group A Streptococcus by testing should be treated with antibiotics to resolve symptoms faster and to prevent complications such as acute rheumautic fever. A single dose of IM penicillin (Bicillin-LA), or 10 days of penicillin VK or amoxicillin are the first-line choices. For patients with non-anaphylactic allergy to penicillin, cephalosporins are the second-line antibiotics of choice (e.g. cephalexin). Macrolides can be used, but there are higher resistance rates to macrolides. After 24 hours from starting therapy, 80-90% of patients will have the organism eradicated from their throats such that they may return to school / work if afebrile. This contrasts with untreated patients, of whom 50% may continue to carry and potentially spread the organism for 3-4 weeks. Tests of cure are not needed if the symptoms resolve and the patient completes the course of therapy. Tonsillectomy decisions are made on a case-by-case basis, not according to the number of infections; also, patients may have been treated in the past based on symptoms alone and actually had viral pharyngitis.