We’ll tell you about some possible causes for rashes in children and adults and explain how rashes can be treated. Top. What antibiotic should be selected? Many antibiotics---such as penicillin-can be used to treat recurrent strep throat infections. Clindamycin or rifampin, in. How to Stop Your Throat from Hurting. Sore throats can be caused by allergies, excessive talking or yelling, pollution, or respiratory infections. Just as there are.
Strep Throat- Recurrentby Michael E. Pichichero, M. D. Professor of Microbiology and Immunology, Pediatrics and Medicine. University of Rochester Medical Center. Elmwood Pediatric Group. If a child or a teenager has repeated episodes of streptococcal tonsillitis or pharyngitis. Are the sore throats actually caused by strep? Many physicians diagnose strep throat infections based on a patient's history and. However, without the aid of a throat culture or a rapid strep detection. The. complaint of a sore throat is frequent in the primary care practice setting. Yet. at the peak of the strep throat infection season (late fall through early spring). Therefore, strictly on a percentage basis, physicians, who diagnose strep in the. Even in a patient with typical symptoms- a fever, a red throat with. In one study, an overestimate. To accurately diagnose strep throat infections, physicians use throat cultures (the. Rapid strep detection tests improve. The accuracy of rapid strep. The critical factor is attention to detail and strictly. Table 1. Causes of Pharyngitis. Peak Incidence (%)Cause. Children. Adults. Bacterial. 3. 0 to 4. GAS. 2. 8 to 4. 0. Group C, G, or F Streptococcus. N gonorrhoeae. 0 to 0. A haemolyticum. 0 to 0. M pneumoniae. 0 to 3. C pneumoniae. 0 to 3. Viral. 1. 5 to 4. Idiopathic. 2. 0 to 5. Data compiled from Reference 1. Did the patient finish the prescribed antibiotic? Patients often do not finish the complete treatment of antibiotics. The symptoms. of strep throat end quickly with antibiotics; patients feel completely better within. Because of this improved well being. Studies from hospital- based clinics and private practices have confirmed that as. In the same populations. Is the problem antibiotic resistance or tolerance? The following antibiotics- penicillin, amoxicillin, and cephalosporins (i. Keflex. Duricef, Ceclor, Lorabid, Ceftin, Cefzil, Vantin, Suprax, Cedax, and Omnicef)- are. Infrequently, strep throat infections. Erythromycin, clarithromycin (Biaxin), and azithromycin (Zithromax). Is the patient experiencing repeated exposure to strep? Some patients are effectively treated for a strep infection with antibiotics, only. The patient. then becomes re- infected and returns to the physician with a recurrent strep throat. Certain circumstances- crowded working conditions, schools, day care settings. One small study and one case. Is the patient not responding to antibiotics? Even when all strep infections are laboratory confirmed with throat cultures or. The highest treatment failure rates observed are with. Penicillin and amoxicillin treatment failures. Patients most likely to experience a penicillin. Has prior antibiotic therapy eliminated protective throat bacteria? Prominent, normal bacteria of the throat include another type of streptococci (alpha. These bacteria make natural antibiotic substances (to provide an advantage. Penicillin or amoxicillin therapy may change the. This is another reason for patients to avoid unnecessary antibiotic. Has early, prompt antibiotic treatment suppressed natural immunity? With the availability of rapid strep detection tests and the publication of several. Immediate penicillin treatment has been shown to be a cause of recurrent strep infections. Early antibiotic treatment suppresses the natural immune response to strep. Delaying. antibiotic therapy for two days after the onset of a sore throat allows an immune. Two similar studies compared immediate penicillin treatment with treatment delayed. Early antibiotic. Table 2. Recurrence Rates of Immediate versus Delayed Treatment of GAS Tonsillopharyngitis. Penicillin. Treatment Group (n)(%)*Recurrent Acute GAS Pharyngitis. Immediate Treatment(n=7. Delayed Treatment(4. Early recurrence. Late recurrence. 2. Total recurrence. Treatment groups compared by x. Fisher's exact test. References 1. 2 and 1. A delay in treatment does not increase the risk of rheumatic fever since a delay. Nevertheless, for patients. Is the patient a strep carrier? A positive throat culture or a rapid strep test alone cannot distinguish between. The strep carrier has a positive throat culture, but. In clinical practice, identifying a strep carrier is problematic. Following treatment, the patient needs to be seen again to determine whether strep. In addition, antibody levels. If antibiotic therapy has been given. Table 3. Short- Course Treatment of Streptococcal Phayngitis. Bacteriologic Cure. Duration of. Rx(days)Cephalosporin or Azithromycin. Penicillin (1. 0 days). Cefuroxime axetil. Cefadroxil. 5. 8. Cefpodoxime proxetil. Cefpodoxime proxetil. Cefuroxime axetil. Cefpodoxime proxetil. Azithromycin. 5. 1. Azithromycin. 5. 1. Data compiled from Reference 1. What antibiotic should be selected? Many antibiotics- -- such as penicillin- can be used to treat recurrent strep throat. Clindamycin or rifampin, in combination with a second antibiotic, such as penicillin. Routine use of clindamycin is not advocated because diarrhea. Rifampin must be used with a second antibiotic. The Difference between a Sore Throat, Strep & TonsillitisThe terms sore throat, strep throat, and tonsillitis often are used interchangeably, but they don't mean the same thing. Tonsillitis refers to tonsils that are inflamed. Strep throat is an infection caused by a specific type of bacteria, Streptococcus. When your child has a strep throat, the tonsils are usually very inflamed, and the inflammation may affect the surrounding part of the throat as well. Other causes of sore throats are viruses and may only cause inflammation of the throat around the tonsils and not the tonsils themselves. Sore Throat. In infants, toddlers, and preschoolers, the most frequent cause of sore throats is a viral infection. No specific medicine is required when a virus is responsible, and the child should get better over a seven to ten day period. Often children who have sore throats due to viruses also have a cold at the same time. They may develop a mild fever, too, but they generally aren't very sick. One particular virus (called Coxsackie), seen most often during the summer and fall, may cause the child to have a somewhat higher fever, more difficulty swallowing, and a sicker overall feeling. If your child has a Coxsackie infection, she also may have one or more blisters in her throat and on her hands and feet (often called Hand, Foot, and Mouth disease). Infectious mononucleosis (often called "Mono") can produce a sore throat, often with marked tonsillitis; however, most young children who are infected with the mononucleosis virus have few or no symptoms. Strep Throat Strep throat is caused by a bacterium called Streptococcus pyogenes. To some extent, the symptoms of strep throat depend on the child's age. Infants: May have only a low fever and a thickened or bloody nasal discharge. Toddlers: May also have a thickened or bloody nasal discharge with a fever. Such children are usually quite cranky, have no appetite, and often have swollen glands in the neck. Sometimes toddlers will complain of tummy pain instead of a sore throat. Children over age three: They are often more ill and may have an extremely painful throat, fever over 1. Fahrenheit (3. 8. Celsius), swollen glands in the neck, and pus on the tonsils. It's important to be able to distinguish a strep throat from a viral sore throat, because strep infections are treated with antibiotics. Diagnosis & Treatment. If your child has a sore throat that persists (not one that goes away after her first drink in the morning), whether or not it is accompanied by fever, headache, stomachache, or extreme fatigue, you should call your pediatrician. That call should be made even more urgently if your child seems extremely ill, or if she has difficulty breathing or extreme trouble swallowing (causing her to drool). Throat culture This may indicate a more serious infection. The doctor will examine your child and may perform a throat culture to determine the nature of the infection. To do this, he will touch the back of the throat and tonsils with a cotton- tipped applicator and then smear the tip onto a special culture dish that allows strep bacteria to grow if they are present. The culture dish usually is examined twenty- four hours later for the presence of the bacteria. Rapid strep test. Most pediatric offices perform rapid strep tests that provide findings within minutes. If the rapid strep test is negative, your doctor may confirm the result with a culture. A negative test means that the infection is presumed to be due to a virus. In that case, antibiotics (which are antibacterial) will not help and need not be prescribed. Antibiotics If the test shows that your child does have strep throat, your pediatrician will prescribe an antibiotic to be taken by mouth or by injection. If your child is given the oral medication, it's very important that she take it for the full course, as prescribed, even if the symptoms get better or go away. If a child's strep throat is not treated with antibiotics, or if she doesn't complete the treatment, the infection may worsen or spread to other parts of her body, leading to conditions such as abscesses of the tonsils or kidney problems. Untreated strep infections also can lead to rheumatic fever, a disease that affects the heart. However, rheumatic fever is rare in the United States and in children under five years old. Prevention. Most types of throat infections are contagious, being passed primarily through the air on droplets of moisture or on the hands of infected children or adults. For that reason, it makes sense to keep your child away from people who have symptoms of this condition. However, most people are contagious before their first symptoms appear, so often there's really no practical way to prevent your child from contracting the disease. In the past when a child had several sore throats, her tonsils might have been removed in an attempt to prevent further infections.
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