From the Guidelines
Referral to an Ear, Nose, and Throat (ENT) specialist is warranted for patients experiencing frequent strep throat, defined as 7 or more episodes in one year, 5 or more episodes per year for two consecutive years, or 3 or more episodes per year for three consecutive years, as stated in the clinical practice guideline by 1. The ENT specialist may consider a tonsillectomy as a treatment option, which involves surgical removal of the tonsils, as recommended by 1. This procedure can significantly reduce the frequency of strep throat infections in patients with documented recurrent episodes. Some key points to consider before referral include:
- Completing full courses of appropriate antibiotics for each strep infection, typically penicillin V (250-500 mg twice daily for 10 days) or amoxicillin (500 mg twice daily for 10 days), or alternatives like clindamycin or azithromycin for those with penicillin allergies.
- Ruling out other contributing factors such as inadequate antibiotic treatment, non-compliance with medication, or household carriers of strep bacteria before proceeding with ENT referral.
- Documenting each episode of sore throat with temperature > 38.3°C (101°F), cervical adenopathy, tonsillar exudate, or positive test for group A beta-hemolytic streptococcus, as suggested by 1. Tonsillectomy is a viable option for patients with recurrent strep throat, as it can reduce the frequency of infections and improve quality of life, according to the guidelines outlined in 1 and 1.
From the Research
Referral to ENT for Frequent Strep Throat
- The decision to refer a patient with frequent strep throat to an ENT (Ear, Nose, and Throat) specialist is typically based on the frequency and severity of episodes, as well as the presence of any underlying conditions that may be contributing to the recurrent infections 2.
- According to the American Family Physician, tonsillectomy is rarely recommended as a preventive measure for recurrent streptococcal pharyngitis, and is typically considered only in cases where the patient has experienced seven episodes in one year, five episodes in each of the past two years, or three episodes in each of the past three years 2.
- The use of antibiotics to treat strep throat is generally recommended, with penicillin and amoxicillin being first-line options 3, 4, 5.
- However, the effectiveness of different antibiotics in preventing recurrent infections is not well established, and more research is needed to determine the best course of treatment for patients with frequent strep throat 4, 5.
Criteria for Referral to ENT
- The following criteria may be used to determine whether a patient with frequent strep throat should be referred to an ENT specialist:
- Frequency and severity of episodes: Patients who experience frequent or severe episodes of strep throat may benefit from referral to an ENT specialist for further evaluation and treatment 2.
- Presence of underlying conditions: Patients with underlying conditions such as tonsillar hypertrophy or adenoid hypertrophy may be more likely to experience recurrent strep throat and may benefit from referral to an ENT specialist 3.
- Failure of antibiotic treatment: Patients who do not respond to antibiotic treatment or who experience recurrent infections despite treatment may benefit from referral to an ENT specialist for further evaluation and treatment 4, 5.
Treatment Options for Frequent Strep Throat
- The following treatment options may be considered for patients with frequent strep throat:
- Antibiotics: Penicillin and amoxicillin are commonly used to treat strep throat, and may be effective in preventing recurrent infections 3, 4, 5.
- Tonsillectomy: Tonsillectomy may be considered in cases where the patient has experienced frequent or severe episodes of strep throat, and may be effective in preventing recurrent infections 2.
- Other treatments: Other treatments such as steroid therapy or immunoglobulin therapy may be considered in certain cases, although the evidence for these treatments is limited 6.