What are the isolation recommendations for a healthcare professional infected with strep (streptococcal) pharyngitis?

Isolation Recommendations for Healthcare Professionals with Strep Pharyngitis

Healthcare professionals with strep pharyngitis should remain isolated from patient care until they have completed at least 24 hours of appropriate antibiotic therapy.

Diagnosis and Treatment Considerations

When a healthcare professional is diagnosed with Group A Streptococcal (GAS) pharyngitis, prompt and appropriate management is essential to prevent transmission in healthcare settings:

1. Diagnostic confirmation:

   • Throat culture or rapid antigen detection test (RADT) should be performed to confirm GAS pharyngitis
   • Clinical features supporting GAS diagnosis include fever, tonsillar exudates, tender anterior cervical lymphadenopathy, and absence of cough 1, 2

2. Antibiotic treatment:

   • First-line therapy: Penicillin or amoxicillin for 10 days (if not allergic) 1, 2
   • For penicillin-allergic individuals:
     • First-generation cephalosporins for 10 days (if not anaphylactically sensitive)
     • Clindamycin or clarithromycin for 10 days
     • Azithromycin for 5 days 1

Isolation Protocol for Healthcare Workers

The primary concern with healthcare workers is preventing transmission to patients and colleagues:

• Duration of isolation: Healthcare workers should not return to patient care until they have completed at least 24 hours of appropriate antibiotic therapy
• Rationale: After 24 hours of antibiotic treatment, patients with GAS pharyngitis are generally no longer contagious 1
• Symptom resolution: While not explicitly required by guidelines, it is prudent for healthcare workers to be afebrile and showing clinical improvement before returning to work

Important Considerations

• Compliance with full treatment course: Even though infectivity is reduced after 24 hours of antibiotics, healthcare workers must complete the full course of antibiotics (typically 10 days for most agents, 5 days for azithromycin) to ensure complete eradication of the organism 1

• Potential complications of untreated infection: Untreated strep pharyngitis can lead to serious complications including:

  • Acute rheumatic fever
  • Post-streptococcal glomerulonephritis
  • Rare but serious sequelae such as pulmonary-renal syndrome 3

• Follow-up testing: Routine post-treatment throat cultures are not recommended for asymptomatic individuals who have completed appropriate antibiotic therapy 1

Special Situations

• Recurrent episodes: Healthcare workers with recurrent episodes of GAS pharyngitis should be evaluated to determine if they are experiencing true infections or are chronic carriers experiencing viral infections 1

• Chronic carriers: Generally do not require treatment as they are unlikely to spread GAS to contacts and are at minimal risk for developing complications 1

• Household contacts: Routine testing or treatment of asymptomatic household contacts is not recommended 1

By following these isolation recommendations, healthcare facilities can minimize the risk of GAS transmission while allowing for the timely return of healthcare professionals to their duties after appropriate treatment has been initiated.