From the Guidelines
A 16-month-old child has an extremely low likelihood of developing streptococcal pharyngitis, with the incidence of strep throat in this age group estimated to be less than 5% of all pharyngitis cases. This low prevalence is due to several factors related to early childhood development, including fewer exposures to group A streptococcus and an immature immune system and oropharyngeal receptors 1. When evaluating a 16-month-old with sore throat symptoms, other causes such as viral infections (particularly respiratory syncytial virus, rhinovirus, or adenovirus) are far more likely explanations.
Key Points to Consider
- The American Academy of Pediatrics and the Infectious Diseases Society of America recommend against routine testing for strep throat in children under 3 years unless there are specific risk factors such as a household contact with confirmed strep infection or if the child shows classic symptoms along with high fever and tender cervical lymphadenopathy 1.
- Diagnostic studies for GAS pharyngitis are not indicated for children <3 years old because acute rheumatic fever is rare in children <3 years old and the incidence of streptococcal pharyngitis and the classic presentation of streptococcal pharyngitis are uncommon in this age group 1.
- Selected children <3 years old who have other risk factors, such as an older sibling with GAS infection, may be considered for testing 1.
Clinical Implications
- Routine testing for strep throat is not recommended in children under 3 years unless there are specific risk factors, and other causes of sore throat symptoms should be considered first 1.
- A negative test result for GAS provides reassurance that the patient likely has a viral cause of pharyngitis, and antibiotics can be safely avoided 1.
From the Research
Streptococcal Pharyngitis in Children
The likelihood of a 16-month-old child having streptococcal pharyngitis can be assessed based on various factors, including symptoms and diagnostic methods.
- The most common bacterial cause of pharyngitis is Group A β-hemolytic streptococcus (GABHS), commonly known as strep throat 2.
- 15-35% of children in the United States with pharyngitis have a GABHS infection 2.
- Symptoms of GABHS overlap with non-GABHS and viral causes of acute pharyngitis, complicating the problem of diagnosis 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.
Diagnostic Methods and Treatment
- Fever, tonsillar exudate, cervical lymphadenitis, and patient ages of 3 to 15 years increase clinical suspicion of streptococcal pharyngitis 3.
- A cough is more suggestive of a viral etiology 3.
- Penicillin and amoxicillin are first-line antibiotics, with a recommended course of 10 days; first-generation cephalosporins are recommended for patients with nonanaphylactic allergies to penicillin 3, 4, 5.
- There is significant resistance to azithromycin and clarithromycin in some parts of the United States 3.