A school-age child with fever, sore throat, exudative tonsils, and a rapid strep test positive presents to the clinic. How should this illness be managed?

A school-age child with fever, sore throat, exudative tonsils, and a rapid strep test positive presents to the clinic. How should this illness be managed?

• A. Administer intramuscular ceftriaxone.
• B. Hospitalize for further diagnostic tests.
• C. Prescribe oral amoxicillin.
• D. Refer to a pediatric infectious disease specialist.

Answer: (C)

When a school-age child has fever, sore throat, exudative tonsils, and a rapid strep test is positive, the goal is to eradicate group A Streptococcus to prevent rheumatic fever and other complications and to reduce contagiousness. Oral amoxicillin is a preferred choice because it is highly effective against GAS, well tolerated in children, usually palatable, and easy to dose for a 10-day course. Treating with an oral antibiotic also helps shorten the period of contagiousness and supports quicker recovery; after at least 24 hours of therapy and becoming afebrile, the child can return to school with appropriate precautions. In addition to antibiotics, provide supportive care such as acetaminophen or ibuprofen for fever and throat pain, fluids, and rest. Intramuscular ceftriaxone is not indicated for routine outpatient strep throat, hospitalization is unnecessary for uncomplicated cases, and referral to an infectious disease specialist isn’t needed unless there are atypical features or complications. If penicillin allergy is present, alternatives can be considered, such as cephalexin if the allergy isn’t severe, or a macrolide if needed.

When a school-age child has fever, sore throat, exudative tonsils, and a rapid strep test is positive, the goal is to eradicate group A Streptococcus to prevent rheumatic fever and other complications and to reduce contagiousness. Oral amoxicillin is a preferred choice because it is highly effective against GAS, well tolerated in children, usually palatable, and easy to dose for a 10-day course. Treating with an oral antibiotic also helps shorten the period of contagiousness and supports quicker recovery; after at least 24 hours of therapy and becoming afebrile, the child can return to school with appropriate precautions. In addition to antibiotics, provide supportive care such as acetaminophen or ibuprofen for fever and throat pain, fluids, and rest. Intramuscular ceftriaxone is not indicated for routine outpatient strep throat, hospitalization is unnecessary for uncomplicated cases, and referral to an infectious disease specialist isn’t needed unless there are atypical features or complications. If penicillin allergy is present, alternatives can be considered, such as cephalexin if the allergy isn’t severe, or a macrolide if needed.