Management of Pharyngitis After Negative Strep Test
Antibiotics should not be used after a negative strep test, and switching to cefdinir is not recommended. 1
Interpretation of Negative Strep Test Results
- A negative rapid antigen detection test (RADT) is sufficient to rule out streptococcal pharyngitis in adults, and antibiotics should be withheld 2
- Routine throat culture after a negative RADT is not necessary in adults 2
- Most cases of pharyngitis with negative strep tests are viral in nature and will resolve without antimicrobial therapy 1
Appropriate Management After Negative Strep Test
- Discontinue any previously started antibiotics when strep test is negative 1
- Focus on symptomatic relief rather than antimicrobial therapy 1
- Either ibuprofen or paracetamol are recommended for relief of acute sore throat symptoms 2
Why Cefdinir Is Not Appropriate
- Cefdinir is indicated for streptococcal pharyngitis that has been confirmed by positive testing 3
- Using antibiotics like cefdinir for strep-negative pharyngitis contributes to antimicrobial resistance 2
- Withholding antibiotics for patients with negative strep tests is considered a quality indicator in healthcare 1
Potential Pitfalls to Avoid
- Treating based on clinical symptoms alone without laboratory confirmation can lead to overuse of antibiotics 2
- Switching from one antibiotic to another without microbiological indication increases the risk of adverse effects without clinical benefit 2
- Diarrhea is a common side effect of cefdinir that occurs in approximately 20% of patients 4, 5
Special Considerations
- If symptoms persist or worsen despite negative strep test, consider other causes of pharyngitis rather than changing antibiotics 2, 1
- In patients with high risk of rheumatic fever or with severe symptoms, clinical judgment should be used, but generally antibiotics should still be withheld with negative tests 2