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Family Health Magazine
CHILDHOOD

Sore Throats
Help for a common complaint

Sore throats are one of the most common reasons why parents take their children to see the family doctor. It may be the only complaint or one of a group of symptoms. Although some think of any sore throat as ‘Strep throat,’ only a few cases are actually caused by the Streptococcus bacteria. A wide range of diseases, most relatively harmless, can be produced by Streptococcus. However, the type known as Group A (GAS) causes a few serious illnesses. Antibiotic treatment of the GAS form of sore throat is generally worthwhile.

Viruses or bacteria other than Strep are responsible for most sore throats. Antibiotics are not recommended for these types of infections, since usually there are no major benefits from the treatment. Some people may experience unwelcome side effects. Using antibiotics unnecessarily also helps bacteria develop resistance to drugs.

Antibiotics should be used carefully, and only by those who truly need them. Antibiotics are not useful if a virus is causing the sore throat, since they can have no effect at all on a virus. Although they may kill other forms of bacteria apart from Strep, the impact on the natural course of an infection is small. All things considered, it is not worthwhile using antibiotics for treatment in these cases.

Diagnosis

It is not easy to decide what is causing a sore throat. Though much effort has gone into finding an easy way to identify sore throats caused by GAS, no reasonable method has yet been found. Certain symptoms indicate that bacteria, especially GAS, may be responsible for the sore throat. These tools are still far from foolproof, even when used by excellent clinicians. The only way to be truly sure that GAS is causing a sore throat is to do a throat culture.

In this procedure, a cotton swab is gently rubbed over the tonsils and surrounding area. The swab is then placed in a special culture medium and sent to a microbiology lab. Any bacteria caught on the swab can be grown and identified. Under ideal conditions, this process takes at least 18 hours. Often, delivery of results to the doctor may be delayed for another 12 to 24 hours.

Although a variety of rapid detection tests have been created, none of the current tests are as sensitive or specific. (Specific means that the test identifies only GAS and does not respond to any other bacteria that may be present.) A further drawback to rapid detection tests is that they are costly (from six to nine dollars per test), and provincial health plans often do not pay for them.

Sadly there is no quick, fast, accurate, and cheap test for GAS. Instead, most doctors rely on clinical judgment to identify the four signs that indicate a sore throat may be caused by GAS. These signs include a high fever (over 38 C or 100.5 F). The ‘glands’ or lymph nodes in the neck will be swollen, and tonsils, if the person still has them, are enlarged. Pus (or purulent exudates) may be in the back of the throat or on the tonsils. Finally, there is no cough. (A virus is much more likely to cause a cough than bacteria.)

If only one of the four symptoms is present, the chance that a sore throat is caused by GAS is low. Even two or three signs do not give a very high indication of GAS. Only when all four signs are present is there is a greater than 50 per cent chance that GAS is the culprit. For this reason, antibiotic treatment is not usually recommended until results from a throat swab verify that a sore throat really is caused by GAS.

Treatment

If the throat swab is positive for GAS, it will normally be treated by a seven to 10 day course of penicillin. For adults, this is usually a form of the drug called Penicillin V, often given as a pill four times a day. Many children, however, cannot take pills and the liquid form of Penicillin V does not taste very good. For this reason, experts recommend that kids be given Amoxicillin instead. It tastes better and most children take it readily. Both drugs have been around for years and are very effective. For those who are allergic to penicillin, other drugs can be used. Regardless of the specific drug prescribed, be sure to finish the prescription. This ensures that all the bacteria are killed and none remain to develop resistance to the drugs.

In many cases, ranging from about 70 per cent of young children to over 90 per cent of adults, simple treatment of symptoms will take care of the sore throat. Acetaminophen (Tylenol™ or Tempra™) or ibuprofen (Advil™ or Motrin™) will help with pain and fever. Children and teens should not be given Aspirin™ (acetylsalicylic acid or ASA) for sore throats. With this drug, there is an increased risk of a rare but serious complication called Reye’s Syndrome.

Gargling with warm salt water will provide temporary relief for some sore throats, as will sucking on lozenges or popsicles. Cool drinks and cool, soft foods can be soothing, while increasing the humidity level in the house may also provide some relief.

None of these methods will work for all children, or even all the time for any one child. Combine any treatment with parental support and time, and your child will be feeling better within a few days