Q: My child has a sore throat. Is it “strep”?

A: The odds are against it. Many things including viruses, bacteria, allergies, smoking, and drinking alcohol can cause sore throats. Viruses are the causative agent roughly 70-80 percent of the time with bacterial causes between 20-30 percent.

Q: Do my symptoms tell me if I have a sore throat caused by bacteria?

A: There can be significant overlap in sore throat symptoms from the variety of causes. However, the classic “textbook” symptoms from bacterial pharyngitis include late fall, winter or early spring presentations with abrupt onset of mid to high fever (101o–104o), painful, enlarged neck glands (lymph nodes), and red or swollen tonsils often with pus type discharge (exudates) in the absence of typical cold symptoms (cough, runny nose or congestion). Despite classic presentations, individuals affected by viruses or allergies can also exhibit some of the above symptoms, as they are not specific to bacteria.

Q: Will I need an antibiotic to make my sore throat better?

A: As a virus causes most sore throats, the majority of instances will not require antibiotics. Group A strep is the only bacterial cause requiring treatment with antibiotics. Recommended treatment is usually the penicillin (penicillin, amoxicillin) or cephalosporin (cephalexin, cefadroxil, cefalcor, cefdinir, cefixime) families of antibiotics. Macrolides (erythromycin, clarithromycin, azithromycin) can also be effective, but increasing rates of resistance are occurring.

Most cases of streptococcal pharyngitis are self-limited and resolve within three to five days if left untreated. Treatment with an antibiotic is primarily aimed at decreasing transmission rates and preventing the rare complications of rheumatic fever, throat abscesses, sinusitis and ear infections. Antibiotics have only a small effect on improving symptoms if initiated within 48 hours from their onset.

Q: If I don’t need antibiotics, what can I do to feel better?

A: First, antibiotics fight bacteria and only secondarily improve pain by decreasing the duration of symptoms by one to two days. Strategies to improve symptoms include drinking plenty of fluids to maintain hydration; scheduled use of over the counter pain relievers like ibuprofen (Advil, Motrin), acetaminophen (Tylenol) or naproxen (Aleve); throat sprays or lozenges (Halls, Sucrets, Cepacol) or even hard candy to keep the throat moist; and home remedies like a salt-water gargle three to four times per day as desired.

Q: Will my other family members need to be treated if exposed to strep throat?

A: Recommendations would be to test individuals if they exhibit symptoms and to treat those with positive test results (either the rapid test or culture). Transmission to close household contacts and classmates is approximately 35 percent, and this is decreased once someone has been on antibiotics for 24 hours. The best prevention would be to wash hands frequently and to not share drinking glasses with family members or friends.