From the Guidelines
This patient's symptoms are more consistent with a viral upper respiratory infection, and given the negative rapid strep test, antibiotics are not indicated at this time. The patient's symptoms of nasal congestion, rhinorrhea, sore throat, and cough for 5 days are more typical of a viral illness, as stated in the clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis 1. Despite the patient's recent exposure to someone with strep throat, the negative rapid strep test suggests that strep throat is unlikely.
Key Considerations
- The patient's rapid strep test is negative, which suggests that strep throat is unlikely 1.
- The patient's symptoms are more consistent with a viral upper respiratory infection, which typically resolves on its own within 7-10 days with supportive care.
- Antibiotics are not indicated for viral respiratory infections, as they can lead to side effects and antibiotic resistance, as noted in the guideline 1.
Recommended Treatment
- Symptomatic treatment with rest, adequate hydration, and over-the-counter medications like acetaminophen or ibuprofen for pain and fever.
- The patient can continue using DayQuil for symptom relief as directed on the package.
- Saline nasal sprays and warm salt water gargles may help with nasal congestion and sore throat.
Follow-up
- If symptoms worsen or don't improve within 7-10 days, or if she develops high fever, difficulty breathing, or severe pain, she should return for reevaluation.
- A throat culture could be considered if there remains high clinical suspicion for strep despite the negative rapid test, as recommended in the guideline 1.
From the Research
Patient Presentation
- The 15-year-old patient presents with a 5-day history of nasal congestion, rhinorrhea, sore throat, and cough, with no improvement in symptoms.
- The patient reports recent exposure to strep and was diagnosed with strep yesterday, starting antibiotic treatment today.
- The patient's symptoms, such as cough and rhinorrhea, are more commonly associated with viral pharyngitis, as noted in studies 2, 3.
Diagnostic Considerations
- The patient underwent a rapid in-office test, which was negative, but this does not rule out the possibility of streptococcal pharyngitis, as the sensitivity and specificity of rapid antigen detection testing can vary 2.
- Throat culture is considered the diagnostic standard, and the modified Centor score can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing, or empiric antibiotic therapy 2.
- Clinical guidelines recommend using clinical decision rules to assess the risk of group A beta-hemolytic streptococcal infection, followed by rapid antigen testing if a diagnosis is unclear, before prescribing antibiotics 3.
Treatment and Management
- The patient was started on antibiotic treatment, which is consistent with guidelines recommending penicillin or amoxicillin as first-line antibiotics for streptococcal pharyngitis 2, 3.
- The recommended course of antibiotic treatment is 10 days, and patients with worsening symptoms after appropriate antibiotic initiation or with symptoms lasting 5 days after the start of treatment should be reevaluated 3.
- There is significant controversy regarding the best methods to diagnose and treat strep throat, and guidelines for diagnosing GABHS created by professional associations vary significantly 4.
- Reducing the duration of antimicrobial therapy is an important strategy for optimizing patient care and reducing the spread of antimicrobial resistance, but the optimal treatment duration for streptococcal pharyngitis is generally recommended to be 10 days 5, 6.