How long should I take absence from work after starting treatment for an infection?

Duration of Work Absence After Starting Treatment for Infection

For most infections, you should stay away from work until at least 24 hours after starting appropriate antibiotic treatment, provided you are fever-free without antipyretics and symptoms have improved.

Infection-Specific Guidelines

Group A Streptococcal (GAS) Infections

Pharyngitis/Throat Infections:

• If symptomatic: Exclude from work until at least 24 hours of appropriate antibiotic therapy AND complete resolution of symptoms 1
• If asymptomatic carrier: Exclude from work until 24 hours of appropriate treatment 1
• The majority (96%) of individuals with pharyngeal carriage will be culture-negative 24 hours after starting treatment 1

Skin Lesions or Other Site Colonization:

• Longer exclusion required compared to throat infections 1
• Should not perform clinical work until eradication is confirmed effective 1
• Time needed for infected skin lesions to heal or for optimal resolution of skin conditions 1
• Requires review by occupational health physician and possible dermatology referral 1

Outbreak-Related Cases:

• Duration determined case-by-case based on clinical situation, transmission risk, colonization site, and evidence of previous transmission 1

COVID-19

Standard Criteria:

• Isolation can be discontinued 10 days after symptom onset, provided you have been fever-free for at least 24 hours without antipyretics and other symptoms have improved 2
• Most patients can return to work after meeting the 10-day criterion plus symptom improvement and 24-hour fever resolution 2

Special Populations:

• Patients with severe COVID-19 or those on immunosuppressive medications require case-by-case determination of isolation length 2

Hand, Foot, and Mouth Disease (HFMD)

• Avoid close contact with others for 7 days from symptom onset 3
• Some studies suggest considering patients potentially contagious for 10-14 days 3
• Return to work should occur only after the acute phase has resolved, typically 7-10 days after symptom onset 3
• Healthcare workers and childcare providers should be especially cautious due to high transmission potential 3

Important Caveats and Considerations

Healthcare Workers Require Stricter Standards

• Healthcare workers pose greater risk to vulnerable patients and require more stringent exclusion criteria 1
• Risk assessment should consider closeness of patient contact and vulnerability of patient population 1
• Symptomatic healthcare workers pose greater risk than asymptomatic carriers 1

Factors That May Prolong Absence

• Physical job demands: Workers with physically heavy jobs may require longer absence 4, 5
• Severity of infection: More severe infections require longer recovery periods 5
• Age: Older workers tend to have longer sickness absence 5
• Comorbidities: Contact with medical specialists and high physical symptoms predict longer absence 5

Risk of Household Transmission

• Persistent or recurrent colonization may indicate re-colonization within the household 1
• Screening of household contacts should be considered in cases of failed eradication 1
• Close personal contacts can be the source of re-infection, frustrating eradication efforts 1

General Principles

• The 24-hour rule applies to most common bacterial infections once appropriate antibiotics are started 1
• Fever resolution without antipyretics is a critical marker for return to work across all infections 1, 2
• Symptom improvement must accompany the time-based criteria 1, 2
• Patients with skin lesions or significant discharge of body fluids require longer exclusion periods 1