From the Guidelines
Group A streptococcal (GAS) infection in a 15-month-old typically presents with fever, irritability, and pharyngitis (sore throat), and diagnosis requires a rapid strep test or throat culture, as clinical presentation alone is insufficient for diagnosis at this age. The child may have difficulty feeding, increased drooling, and refusal to eat due to throat pain. On examination, the throat often appears red with enlarged tonsils that may have white or yellow exudate. Cervical lymph nodes are frequently enlarged and tender. Unlike older children, 15-month-olds may not complain of specific throat pain but instead show general fussiness and decreased oral intake. Some infants develop a fine, sandpaper-like rash (scarlet fever), particularly on the trunk and in skin folds.
Clinical Presentation
The clinical presentation of GAS infection in a 15-month-old can be non-specific, making diagnosis challenging. However, some common features include:
- Fever
- Irritability
- Pharyngitis (sore throat)
- Difficulty feeding
- Increased drooling
- Refusal to eat
- Red, enlarged tonsils with white or yellow exudate
- Enlarged and tender cervical lymph nodes
- Fine, sandpaper-like rash (scarlet fever) in some cases
Diagnosis and Treatment
Diagnosis of GAS infection requires a rapid strep test or throat culture, as clinical presentation alone is not sufficient for diagnosis at this age 1. Treatment consists of amoxicillin 40-50 mg/kg/day divided twice daily for 10 days, or penicillin if the child has no allergies. Alternative options for penicillin-allergic children include azithromycin or clindamycin. Prompt treatment is important to prevent complications such as rheumatic fever, although this is rare in children under 3 years old 1. Caregivers should ensure the full antibiotic course is completed even if symptoms improve quickly.
Recent Guidelines
Recent guidelines suggest that standard-dose penicillin should generally be given for 10 days, but oral cephalosporins or high-dose penicillin given four times daily may be alternatives 1. However, the choice of antibiotic and duration of treatment should be individualized based on the child's specific needs and medical history.
Key Considerations
Key considerations in the management of GAS infection in a 15-month-old include:
- Prompt diagnosis and treatment to prevent complications
- Completion of the full antibiotic course to ensure eradication of the infection
- Monitoring for signs of complications, such as rheumatic fever
- Individualization of treatment based on the child's specific needs and medical history.
From the Research
Presentation of Group A Strep in 15-Month-Old Children
- Group A strep can present with varied clinical symptoms in children, including fever, pneumonia, and empyema 2
- In children, the most common presenting symptom of Group A strep is fever, and pneumonia with or without empyema is the most common diagnosis 2
- Children with Group A strep pharyngitis may exhibit symptoms such as sore throat, tonsillar exudate, and cervical lymphadenitis 3, 4
- The diagnosis of Group A strep pharyngitis is typically made using a throat swab and rapid antigen testing, followed by a throat culture if the results are negative 3, 4
Antibiotic Treatment for Group A Strep in Children
- Penicillin and amoxicillin are commonly used antibiotics for the treatment of Group A strep pharyngitis in children 3, 4
- Cephalosporins and macrolides may also be used as alternative antibiotics, but the evidence for their effectiveness is limited 5, 6
- The choice of antibiotic should be based on the individual child's needs and medical history, as well as the severity of the infection 5, 6
Complications and Outcomes of Group A Strep in Children
- Group A strep infections can lead to serious complications, such as acute rheumatic fever and post-streptococcal glomerulonephritis 2, 3
- Early diagnosis and treatment with antibiotics can help prevent these complications and improve outcomes for children with Group A strep infections 2, 3
- Children with Group A strep pharyngitis should be monitored closely for signs of complications and treated promptly if they occur 3, 4