Kids with Strep Throat May Not Have to Miss School

The US Centers for Disease Control and Prevention (CDC) considers strep throat to be contagious and currently recommends that infected children delay returning to school or day care until they have taken antibiotics for at least 24 hours.

Of note, the CDC’s recommendation is supported by the American Academy of Pediatrics and the American Academy of Family Practice. However, a recent study published in The Pediatric Infectious Disease Journal suggests that missing school or day care due to streptococcal pharyngitis may not be necessary.

The study authors evaluated 111 children who presented with sore throat, had a positive streptococcal rapid antigen detection test (RADT), and tested positive for Group A Streptococcus. These patients were randomly assigned to 2 treatment groups.

In the first treatment group, patients received a single 50 mg/kg/day dose of amoxicillin suspension during their initial office visit, as well as a repeat dose one hour prior to their office visit the following day. In the second treatment group, patients only received a 50 mg/kg/day dose of amoxicillin during their initial office visit.

Repeat throat cultures were taken during the subsequent office visit the day following the initial presentation.

In the first group, 10% of patients had a positive RADT the morning after their initial visit, compared with 8% of the second group (p = 0.75). Furthermore, Group A Streptococcus was undetectable in 91% of all 111 children enrolled in the study who were tested 11 to 23 hours after their initial office visit, regardless of their treatment group.

Although this study was conducted at a single site, the authors concluded that if a child takes a single 50 mg/kg/day dose of amoxicillin at least 12 hours prior to his or her arrival at school the next day, then return to school should be permitted if the child is afebrile, has improved symptomology, and local guidelines are modified to allow the child’s return.

The study authors suggested that such steps may produce significant financial savings, improve school attendance, and reduce the number of sick days and lost productivity taken by working parents caring for their sick kids. However, the results of this study should be interpreted cautiously, as allowing a child who remains contagious to return to school or day care may also have significant negative implications for other children and their families, as well as school and day care workers.

Reference

Schwartz RH, Kim D, Martin M, Pichichero ME. A reappraisal of the minimum duration of antibiotic treatment before approval of return to school for children with Streptococcal pharyngitis. Pediatr Infect Dis J. 2015;34:1302-1304.