Treatment of Viral Pharyngitis in a 15-Year-Old with Negative Strep Test
For a 15-year-old with viral pharyngitis and a negative strep test, provide symptomatic treatment only with analgesics (ibuprofen or acetaminophen) and withhold antibiotics entirely. 1
Confirming the Diagnosis
Since this patient is an adolescent (age 15), you must confirm the negative rapid strep test with a backup throat culture before making final treatment decisions. 2, 1
- The Infectious Diseases Society of America recommends backup throat culture in children and adolescents because rapid antigen detection tests have sensitivities of only 80-90%, missing 10-20% of true strep infections. 1
- However, antibiotics should be withheld while awaiting culture results. 1
- If the culture returns positive, antibiotics can be initiated at that time—treatment within 9 days of symptom onset still prevents acute rheumatic fever. 1
Symptomatic Management
Provide analgesics and antipyretics for symptom relief:
- Either ibuprofen or acetaminophen (paracetamol) are recommended for relief of acute sore throat symptoms. 1
- Throat lozenges may provide additional comfort. 1
- Reassure the patient and family that symptoms typically resolve in less than 1 week. 1
Why Antibiotics Should Be Withheld
Antibiotics provide minimal benefit and carry unnecessary risks in viral pharyngitis:
- Antibiotics shorten sore throat duration by only 1-2 days, with a number needed to treat of 6 at 3 days and 21 at 1 week. 1
- Up to 70% of patients with sore throats receive unnecessary antibiotic prescriptions, while only 20-30% of pharyngitis cases in the 5-15 age group are actually due to Group A streptococcus. 1
- Treating based on clinical symptoms alone without laboratory confirmation leads to overuse of antibiotics and contributes to antimicrobial resistance. 1
Common Viral Causes
The most likely viral pathogens causing this patient's pharyngitis include adenovirus, influenza, parainfluenza, rhinovirus, respiratory syncytial virus, coxsackievirus, echoviruses, and herpes simplex virus. 1
What NOT to Do
Avoid these common pitfalls:
- Do not prescribe antibiotics based on clinical appearance alone (such as presence of exudate or white patches), as these findings overlap too broadly between bacterial and viral causes. 1
- Do not test or treat asymptomatic household contacts—screening or prophylactic treatment of contacts is not recommended. 1
- Do not switch from one antibiotic to another without microbiological indication, as this increases the risk of adverse effects without clinical benefit. 1
When to Reconsider
If symptoms persist beyond 3-4 days or worsen significantly, consider suppurative complications or alternative diagnoses and reassess the patient. 1