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At Children’s Hospital (CHOP) the emergency room and clinics are always busy. A 5-year-old white male child in good general health and physical...

The symptoms described in the student's question are consistent with a diagnosis of strep throat. In fact, they are a textbook definition of strep throat. The inflammation of the tonsils would, obviously, suggest a potential for tonsillitis, but absent a history of such inflammation, and given the additional information provided, especially the reference to a positive lab result for a Strep swab, the most likely condition is strep throat, caused by the Streptococcus bacteria. Sore throats can be either viral or bacterial. In the case of the former, the condition can be expected to disappear on its own, with over-the-counter medications, mainly acetaminophen or ibuprofen, given to the child to reduce the fever and soreness. In the case of a bacterial infection, however, an antibiotic will generally be prescribed. Unfortunately, a history of over-prescription of antibiotics has rendered them increasingly ineffective due to the emergence of antibiotic-resistant strains of bacteria. Consequently, whereas, in the past, penicillin or a derivative such as amoxicillin would have been routinely prescribed to treat strep, today a child is as or more likely to be prescribed Cephalosporins (e.g., ceftaroline) or macrolides, such as Azithromycin. [In addition to the problem of over-use of penicillin and its derivatives, there is also the concern regarding an allergic reaction on the part of the patient, thereby mitigating against the use of this particular family of antibiotics.]


When individuals are tested for possible infection by the Streptococcus bacteria, it is often a two-stage process. The rapid test, as was used in the case posted by the student, may be negative, but false negatives do occur. A second test is usually prepared, as a consequence. This second test involves a throat culture, the results of which will take several days. As the risk of allowing a strep infection in a child to go untreated may be considered unacceptable, even though the infection will likely go away on its own, antibiotics may be prescribed as a precautionary measure. Additionally, the fact that strep throat is contagious often warrants use of antibiotics to prevent its spread.


Follow-up diagnostic measures will only likely be performed in the event the condition does not respond to antibiotics or does not otherwise go away on its own. As noted, however, a positive rapid strep test is an indication of the presence of the Streptococcus bacteria, so, in the case in question, treatment of the condition using antibiotics will usually be the path chosen by attending physicians. In the case of a negative rapid test, the results of the throat culture will be used to determine the course of treatment, except, of course, when antibiotics are prescribed as a precautionary measure pending receipt of results of the culture. In the event the condition does not respond to treatment, removal of the tonsils might be recommended.


While strep throat should go away on its own, with the child's symptoms being relieved through the aforementioned pain/fever reducers, rest, and plenty of fluids, use of antibiotics remain common because of the risk of untreated strep resulting in a very serious medical problems. These problems include rheumatoid fever and potential damage to the heart and/or kidneys -- not risks most parents want to take when the patient is their 5-year-old child.

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