Strep Throat: Treated Kids Can Return to School in 12 Hours

Tara Haelle

September 02, 2015

Children treated with amoxicillin for strep throat may return to school the next day without putting other children at risk for contracting the illness, suggests a study published online August 20 in the Pediatric Infectious Disease Journal.

Current national and state public health recommendations stipulate that children should not return to school for at least 24 hours after testing positive for group A streptococci and beginning antibiotics. Yet a handful of small studies have found that positive cultures were unlikely as early as 18 hours after taking the antibiotic.

"In families where there are no stay-at-home parents the results of this study are meaningful," write Richard Schwartz, MD, from Inova Children's Hospital's Department of Pediatrics in Falls Church, Virginia, and colleagues. "If amoxicillin as a single dose is ingested by 5PM (at least 12 hours before arrival at school the following day), a return to school the next morning should be permitted by a modification of the state guidelines for return to school after diagnosis of strep throat." Such a policy change could lead to significant financial savings, improved school attendance, and reduced sick day usage by parents, the authors explain.

The researchers enrolled 111 children who had both a positive rapid strep test and a positive throat culture for group A streptococci when they visited a pediatric practice in Vienna, Virginia, between August 2013 and March 2015. Throat swab specimens were obtained and the children received an initial dose of amoxicillin 50 mg/kg/day. Between 12 and 23 hours after the first dose, all children returned for another throat swab, ear temperature reading, and oropharynx examination.

On the second day, 91% had undetectable group A streptococci on the rapid test, and on the throat culture (confidence interval [CI], 86% - 96%). There was no significant difference between those who had received a second antibiotic dose that morning (10% of 60 tested positive) compared with those who had not yet received their second dose (8% of 51 tested positive; P = .75).

The quantity of group A streptococci in throat cultures dropped from at least 50 beta-hemolytic colonies to fewer than 50 for all except two of the children (one with and one without a second dose), who tested positive the following morning.

"We conclude that all children treated with amoxicillin for streptococcal pharyngitis by 5 PM can, if afebrile and improved...be permitted to attend school on day 2," the authors write.

Pediatric Infect Dis J. Published online August 20, 2015. Abstract

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