A school-age child has abrupt onset sore throat, fever, and exudative tonsils with a negative RADT. What is the next step in management?

A school-age child has abrupt onset sore throat, fever, and exudative tonsils with a negative RADT. What is the next step in management?

• A. Consider a sexual abuse diagnosis.
• B. Obtain an anti-streptococcal antibody titer.
• C. Perform a follow-up throat culture.
• D. Prescribe amoxicillin for 10 days.

Answer: (C)

In kids, a negative rapid strep test doesn’t rule out group A Streptococcus pharyngitis, especially when the clinical picture is strongly suggestive. The next step is to get a throat culture to confirm the diagnosis. Throat culture is more sensitive and is the standard for evaluating suspected GAS infection when the RADT is negative in children. If the culture comes back positive, you would treat with a penicillin-class antibiotic for about 10 days; if it’s negative, antibiotics aren’t needed. The other options don’t fit because a sexual abuse diagnosis isn’t indicated by this presentation, antibody titers aren’t useful for acute diagnosis, and giving antibiotics without confirmation risks treating a non-GAS illness and promoting unnecessary antibiotic exposure.

In kids, a negative rapid strep test doesn’t rule out group A Streptococcus pharyngitis, especially when the clinical picture is strongly suggestive. The next step is to get a throat culture to confirm the diagnosis. Throat culture is more sensitive and is the standard for evaluating suspected GAS infection when the RADT is negative in children. If the culture comes back positive, you would treat with a penicillin-class antibiotic for about 10 days; if it’s negative, antibiotics aren’t needed. The other options don’t fit because a sexual abuse diagnosis isn’t indicated by this presentation, antibody titers aren’t useful for acute diagnosis, and giving antibiotics without confirmation risks treating a non-GAS illness and promoting unnecessary antibiotic exposure.