Toothbrush Replacement for Strep Throat
Patients with strep throat do not need to change their toothbrushes, as this practice has no impact on treatment outcomes or recurrence rates.
Evidence Against Toothbrush Replacement
The most definitive evidence comes from a prospective study that directly tested whether hygienic measures, including toothbrush changes, affect strep pharyngitis recurrence. In a study of 114 patients with group A streptococcal pharyngitis, there was no difference in treatment failure rates between patients who changed their toothbrushes (and took other hygienic measures) versus those who did not—both groups had a 35% recurrence rate 1. This demonstrates that toothbrush contamination does not play a meaningful role in reinfection or treatment failure 1.
Understanding Recurrent Positive Tests
When patients have persistent or recurrent symptoms after treatment, the explanation is typically not toothbrush recontamination but rather:
- Carrier state with concurrent viral infection (most common explanation) 2, 3
- Poor compliance with the antibiotic regimen 2, 3
- New infection from close contacts (family, school, or community) 2, 3
- Macrolide resistance if treated with azithromycin or similar antibiotics 3
- True treatment failure (rare with appropriate antibiotics) 3
Up to 20% of asymptomatic school-aged children are streptococcal carriers during winter and spring, and these carriers have group A streptococci in their throats without evidence of immunologic reaction 2, 3. Carriers are at low risk for complications and unlikely to spread the organism to close contacts 3.
What Actually Matters for Strep Throat Management
Instead of focusing on toothbrush replacement, prioritize:
- Completing the full 10-day course of penicillin or amoxicillin (first-line therapy) 4
- Considering testing and treating household contacts only in specific situations with repeated infections 2, 3
- Avoiding routine post-treatment testing unless symptoms persist or the patient has special risk factors (history of rheumatic fever) 3
Common Pitfall to Avoid
Do not interpret a positive throat culture after treatment as treatment failure when the patient is asymptomatic—this likely represents the carrier state, not active infection 3. Unnecessarily retreating asymptomatic carriers should be avoided 3.