Managing Strep Throat

Strep throat, or pharyngitis, is a common infection caused by group A streptococcus bacteria. While it’s technically possible for this infection to resolve on its own (1), the risk of serious complications leads many doctors to proactively prescribe antibiotics for strep throat. This article aims to provide parents with essential information about strep throat, its treatment, and potential side effects, as well as how to manage symptoms at home and when to seek medical attention.

Signs & Symptoms of Strep Throat

According to the CDC, symptoms* often include:

• Sudden-onset sore throat
• Painful swallowing
• Fever

*These symptoms typically occur without typical cold symptoms like coughing or runny nose (2). 

Additional symptoms may include: headache, stomach ache, nausea, vomiting, small red spots at the back of the mouth, swollen lymph nodes, and red/swollen tonsils. 

Identifying strep throat involves recognizing its signs. It’s important to distinguish strep throat from viral infections, as antibiotics are most effective for strep when started within 48 hours of symptom onset (3). If you suspect you, or your child, have strep throat, it is important to see your medical provider.

Strep throat is contagious and can be spread through respiratory droplets or by touching the nose or mouth after touching contaminated surfaces. Thorough hand washing and consistent covering of the nose and mouth when coughing or sneezing play an important role in preventing the spread of strep throat (2).

Strep Infection In Babies & Toddlers

Toddlers and babies may get a strep infection if exposed to someone with strep throat; however, they don’t usually exhibit sore throat symptoms. Instead they may get a mild condition called streptococcal fever, or streptococcosis, and they may exhibit the following symptoms: 

• Thick opaque nasal discharge
• Loss of appetite
• Irritability
• Low fever 

Babies and toddlers are not usually evaluated for strep throat unless they have a close contact (eg. sibling or someone in daycare with them) who has been diagnosed with strep throat (4).

Serious complications of strep throat (eg. rheumatic fever) are unusual in children under 3 years old (4). Therefore, antibiotics aren’t as important for this age group; however, antibiotic treatment may still be desired in order to speed recovery and reduce spread. 

Potential Complications Of Strep Throat In Children

If left untreated, strep throat in children can lead to potential complications and more serious strep infections. These complications may include infection of deeper tissues (sinuses, tonsils, middle ear, skin, blood), scarlet fever, rheumatic fever, kidney disease, pneumonia, and PANDAS.

Rheumatic fever is an inflammatory condition that can affect the heart, joints, skin, and other tissues. Rheumatic fever is estimated to affect up to 1-3% of patients with untreated group A streptococcus bacteria. Out of this group, 60% of the cases of rheumatic fever will be chronic. (4).

Untreated strep throat may also lead to post-streptococcal glomerulonephritis, a kidney-related complication that is exceedingly rare in America but continues to occur in at least 9 cases per 100,000 in countries with limited access to antibiotics (5).

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) is another consideration. PANDAS is a pediatric condition in which streptococcal infections trigger neuropsychiatric symptoms, such as obsessive-compulsive disorder (OCD) and tics. Though estimates vary, it is thought to occur in about 1 per 1000 children (6), but research in this area is relatively new and still developing.

These complications underscore the importance of timely and appropriate medical intervention to address strep throat in children, preventing the possible progression to more severe health issues. 

Antibiotics For Strep Throat

In order to prevent the complications described above, antibiotics are indicated for strep throat. In the absence of an allergy, the antibiotics most commonly prescribed for strep throat are penicillin and amoxicillin. For those with an allergy to penicillin, clindamycin, clarithromycin, or azithromycin can be prescribed (7).

Aside from preventing complications, one of the benefits of antibiotic treatment of strep throat is a reduction in the amount of time that the child is infectious; according to the American Academy of Pediatrics, children with group A strep pharyngitis may return to school or a childcare setting 12-24 hours after beginning appropriate antibiotic therapy and feeling well (2). 

Taking a probiotic that contains Saccharomyces boulardii and Lactobacillus rhamnosus may reduce antibiotic associated diarrhea and help reduce antibiotic associated dysbiosis (8,9). If some occasional digestive upset occurs, ginger root can offer gentle support (10).

For more information on supporting the body while taking antibiotics, see: How To Avoid Side Effects Of Antibiotics Using Natural Medicine.

Home Strategies for Soothing A Sore Throat

Home care plays a role in managing the symptoms of strep throat, which can be very uncomfortable. It is important to understand that managing bothersome symptoms at home does not replace the need for medical care and antibiotics. These tips are to help you feel better while taking the medication prescribed by your doctor.

The kitchen is a good place to start when it comes to homecare. Try brewing an Herbal Sore Throat Tea with common spices like cloves and cinnamon. Focus on soft, easy to swallow foods and try to stay away from sugar and other inflammatory foods. Healthy popsicles, congee, chia pudding, herbal tea with honey, and bone broth are all great options. 

Steam inhalation is another great option to soothe the throat. For babies and young children, I recommend spending some time in a steamy bathroom. Older kids and adults can carefully utilize botanical steam inhalation to soothe the throat.

Pain Medication Considerations

Over-the-counter pain and fever medications, like Ibuprofen and Tylenol, come with side effects but should be considered in certain situations when symptoms interfere with essential activities like eating, drinking, or sleep or when help is needed managing a fever. 

For more information about Tylenol and Ibuprofen, see: Are Over The Counter Painkillers Safe?

Immune Support During Illness

As is the case when facing most acute bacterial or viral illnesses, it may be wise to provide a little extra support to our immune system when we are fighting a strep infection. Strategies to support the immune system include:

1. Minimize sugar and processed foods and choose nutritionally dense whole foods that are easy to swallow and digest.
2. Stay well-hydrated with options like homemade electrolyte drinks and healthy popsicles.
3. Consider adding immune supporting herbs to your routine, such as elderberry and ginger (11,12).
4. Consider immune supporting nutrients like vitamin D, zinc, and vitamin C (13,14,15).

When To See A Doctor

The American Academy of Pediatrics recommends taking your child to the doctor for a sore throat if it doesn’t go away after their first drink of the morning (16). Time is of the essence because antibiotics are most effective when administered within 48 hours of symptom onset. Your doctor will most often administer a rapid strep test in office. If this test is positive, they will prescribe antibiotics. If this test is negative, but your doctor still suspects strep, they may collect a throat swab sample and send it to a lab to be cultured.

When to Get Emergency Care

Emergency care is rarely needed for strep throat, but it is necessary for severe symptoms like a high fever (over 104°F), difficulty breathing or swallowing, or unusual drooling. Never hesitate to get emergency care if you think it is needed.

Summary

Strep throat can be managed with a comprehensive approach that combines medical intervention and symptom relief through home care. As with most illnesses, strep throat can benefit from general immune support, but this does not replace the need for medical care. It is important for parents to be aware of the signs of strep throat as antibiotics work best when administered within 48 hours of symptom onset and complications such as rheumatic fever can occur when strep throat is not treated with antibiotics. 

References:

1. CDC. (2019, April 19). Group A Strep | Strep Throat | For Clinicians | GAS | CDC. Www.cdc.gov. https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html#treatment
2. CDC. (2023, January 6). Strep throat: All you need to know. Centers for Disease Control and Prevention. https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html
3. Mayo Clinic. (2018). Strep throat – Diagnosis and treatment – Mayo Clinic. Mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/strep-throat/diagnosis-treatment/drc-20350344
4. de Loizaga, S. R., & Beaton, A. Z. (2021). Rheumatic Fever and Rheumatic Heart Disease in the United States. Pediatric annals, 50(3), e98–e104. https://doi.org/10.3928/19382359-20210221-01
5. Rodriguez-Iturbe B, Haas M. Post-Streptococcal Glomerulonephritis. 2016 Feb 10. In: Ferretti JJ, Stevens DL, Fischetti VA, editors. Streptococcus pyogenes : Basic Biology to Clinical Manifestations [Internet]. Oklahoma City (OK): University of Oklahoma Health Sciences Center; 2016-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK333429/
6. Wald, E. R., Eickhoff, J., Flood, G. E., Heinz, M. V., Liu, D., Agrawal, A., Morse, R. P., Raney, V. M., Aravindhan Veerapandiyan, & Madan, J. C. (2023). Estimate of the incidence of PANDAS and PANS in 3 primary care populations. Frontiers in Pediatrics, 11. https://doi.org/10.3389/fped.2023.1170379
7. Ashurst JV, Edgerley-Gibb L. Streptococcal Pharyngitis. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525997/
8. ‌Ehrhardt, S., Guo, N., Hinz, R., Schoppen, S., May, J., Reiser, M., Schroeder, M. P., Schmiedel, S., Keuchel, M., Reisinger, E. C., Langeheinecke, A., de Weerth, A., Schuchmann, M., Schaberg, T., Ligges, S., Eveslage, M., Hagen, R. M., Burchard, G. D., & Lohse, A. W. (2016). Saccharomyces boulardii to Prevent Antibiotic-Associated Diarrhea: A Randomized, Double-Masked, Placebo-Controlled Trial. Open forum infectious diseases, 3(1), ofw011. https://doi.org/10.1093/ofid/ofw011
9. Kopacz, K., & Phadtare, S. (2022). Probiotics for the Prevention of Antibiotic-Associated Diarrhea. Healthcare (Basel, Switzerland), 10(8), 1450. https://doi.org/10.3390/healthcare10081450
10. Zhang, C., Huang, Y., Li, P., Chen, X., Liu, F., & Hou, Q. (2020). Ginger relieves intestinal hypersensitivity of diarrhea predominant irritable bowel syndrome by inhibiting proinflammatory reaction. BMC complementary medicine and therapies, 20(1), 279. https://doi.org/10.1186/s12906-020-03059-3
11. Wieland, L. S., Piechotta, V., Feinberg, T., Ludeman, E., Hutton, B., Kanji, S., Seely, D., & Garritty, C. (2021). Elderberry for prevention and treatment of viral respiratory illnesses: a systematic review. BMC complementary medicine and therapies, 21(1), 112. https://doi.org/10.1186/s12906-021-03283-5
12. Mao, Q. Q., Xu, X. Y., Cao, S. Y., Gan, R. Y., Corke, H., Beta, T., & Li, H. B. (2019). Bioactive Compounds and Bioactivities of Ginger (Zingiber officinale Roscoe). Foods (Basel, Switzerland), 8(6), 185. https://doi.org/10.3390/foods8060185
13. Aranow C. (2011). Vitamin D and the immune system. Journal of investigative medicine : the official publication of the American Federation for Clinical Research, 59(6), 881–886. https://doi.org/10.2310/JIM.0b013e31821b8755
14. Wessels, I., Maywald, M., & Rink, L. (2017). Zinc as a Gatekeeper of Immune Function. Nutrients, 9(12), 1286. https://doi.org/10.3390/nu9121286
15. Carr, A. C., & Maggini, S. (2017). Vitamin C and Immune Function. Nutrients, 9(11), 1211. https://doi.org/10.3390/nu9111211
16. Mayo Clinic. (2021, June 10). Sore throat – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/sore-throat/symptoms-causes/syc-20351635