From the Guidelines
Having strep throat three times in one year is concerning and warrants medical attention, but according to the most recent and highest quality study 1, watchful waiting is recommended if there have been fewer than 7 episodes in the past year. You should see your healthcare provider for evaluation, as recurrent strep infections may indicate several possibilities: you might be a strep carrier, have incomplete treatment of previous infections, or have household members who are carriers. Your doctor will likely perform a throat culture and may recommend a longer course of antibiotics such as penicillin V (250-500 mg twice daily for 10 days) or amoxicillin (500 mg twice daily for 10 days) as suggested by 1. For penicillin-allergic patients, alternatives include clindamycin or azithromycin. In cases of true recurrent infections, your doctor might consider tonsillectomy, especially if the infections are causing significant complications or disrupting your quality of life, as stated in 1 and 1. To prevent future infections, complete the full course of antibiotics even if symptoms improve, replace your toothbrush after starting antibiotics, practice good hand hygiene, and avoid sharing utensils or drinks. Some key points to consider include:
- Strep throat is caused by group A Streptococcus bacteria that spread through respiratory droplets, and recurrent infections can lead to complications like rheumatic fever or kidney inflammation if left untreated.
- The decision to perform a tonsillectomy should be based on the frequency and severity of infections, as well as the patient's response to treatment, as mentioned in 1.
- Watchful waiting does not imply inaction, and patients should be closely monitored and episodes of pharyngotonsillitis accurately documented, as stated in 1. The current evidence suggests that tonsillectomy may be considered for recurrent throat infection with a frequency of at least 7 episodes in the past year, at least 5 episodes per year for 2 years, or at least 3 episodes per year for 3 years, as recommended by 1 and 1.
From the Research
Implications of Recurring Acute Pharyngitis
The implications of recurring acute pharyngitis (strep throat) three times in one year can be significant. According to the studies, recurring infections can lead to:
- Increased risk of complications, such as acute rheumatic fever and post-streptococcal glomerulonephritis 2
- Potential need for alternative treatments, such as tonsillectomy, if the frequency of infections meets certain thresholds (e.g., seven episodes in 1 year, five episodes in each of the past 2 years, or three episodes in each of the past 3 years) 3
- Consideration of different antibiotic treatments, as some studies suggest that certain antibiotics may be more effective in preventing clinical relapse or reducing symptoms 4
Treatment Options
Treatment options for recurring acute pharyngitis may include:
- Alternative antibiotic regimens, such as clindamycin, which has been shown to be effective in reducing the risk of recurrence 5
- Shortened antibiotic courses, such as 5- to 7-day regimens, which have been found to be effective in managing acute streptococcal pharyngitis 6
- Tonsillectomy, which may be considered in cases where the frequency of infections meets certain thresholds 3
Considerations
When considering treatment options for recurring acute pharyngitis, it is essential to: