From the Guidelines
Guidelines do not recommend routine reswabbing for strep throat after completing antibiotic treatment. Once a patient has completed the full course of antibiotics, follow-up testing is unnecessary for asymptomatic patients 1. This recommendation exists because many people can be asymptomatic carriers of group A streptococcus without being infectious or requiring treatment.
Key Points to Consider
- Post-treatment cultures are only recommended in specific situations, such as:
- Patients with a history of rheumatic fever
- During outbreaks of rheumatic fever or post-streptococcal glomerulonephritis
- When symptoms persist or recur after treatment
- In communities with high rates of rheumatic fever 1
- The primary goal of strep throat treatment is to prevent complications like rheumatic fever and reduce symptom duration, not to completely eliminate the organism from the throat 1
- If symptoms persist after treatment, clinical evaluation is warranted rather than automatic reswabbing
Clinical Considerations
In many instances, the clinician may not be able to distinguish persistent carriage from acute infection and will elect to administer another course of antimicrobials 1. For a single episode of pharyngitis associated with laboratory confirmation of GAS that occurs shortly after completion of a course of appropriate antimicrobial therapy, treatment with any of the agents listed is appropriate. Since patient adherence to oral antimicrobial therapy often is an issue, intramuscular benzathine penicillin G should be considered 1.
Special Circumstances
For patients with frequent discrete episodes, information regarding the precise nature of the presenting signs and symptoms, the clinical response to antibiotic therapy, and the presence or absence of GAS pharyngitis in cultures of throat swabs obtained during asymptomatic intervals is helpful in distinguishing persistent carriage from recurrent episodes of acute GAS pharyngitis 1. Serotyping or genotyping of streptococcal isolates recovered from specimens obtained during distinct episodes from an individual patient may also assist in arriving at this determination because a carrier has persistence of the same strain of GAS over time 1.
From the FDA Drug Label
Cultures should be taken following completion of treatment to determine whether streptococci have been eradicated.
The guidelines recommend taking cultures after completing treatment for strep to determine whether the streptococci have been eradicated, which implies reswabbing for strep after treatment. 2
From the Research
Guidelines for Reswabbing for Strep after Completing Treatment
- The provided studies do not explicitly recommend reswabbing for strep after completing treatment 3, 4, 5, 6, 7.
- However, some studies suggest that patients can remain PCR positive for Group A Streptococcus (GAS) even after completing a standard course of antibiotic therapy 7.
- One study found that 45% of patients had a positive PCR 2-4 days after the initial positive swab, and 20% remained positive 14-18 days later 7.
- The same study suggests that if a patient presents with symptoms of GAS pharyngitis after previous positive GAS PCR testing and treatment with appropriate antibiotics, it is reasonable to use PCR testing for GAS pharyngitis testing beginning one week after initial testing 7.
- Another study recommends that children with group A beta-hemolytic streptococcal pharyngitis should complete a full 24 hours of antibiotics before returning to school or daycare, but does not address reswabbing specifically 5.
- The American Academy of Pediatrics Committee on Infectious Diseases recommends that patients with group A beta-hemolytic streptococcal pharyngitis wait until they have completed 24 hours of antibiotics before returning to school or daycare, but does not provide guidance on reswabbing 5.