Posts Tagged ‘fever’

I’m seeing an unusually high number of strep throat cases in my practice these past few weeks. I’d like to explain about sore throats and strep throat in particular.

Sore throats are caused by many things. Most commonly, they are caused by an infection, usually by viruses and sometimes by bacterial germs such as the strep germ, officially called streptococcus.

The sore throat from a virus is by far the most common variety and is usually accompanied by cold-like symptoms, such as a cough and runny nose. This type of sore throat is really just one of the many irritating symptoms of the cold virus and will run its course without the need of antibiotics. It often lasts three to 10 days. It is rarely associated with a fever.

Strep throat is caused by the streptococcus bacteria and can often feel like any other type of sore throat. It is most common in childhood and tapers off as one gets older. Some lucky people never get it, and some get it often. What’s important and different about strep throat is that if it is left untreated with antibiotics, it can once in a while lead to rheumatic fever, a disease of the heart valves. It can also lead to glomerulonephritis, an inflammation of the kidneys. Strep throat can also cause a fine red rash on the body called scarlet fever, which has a very scary sound to it, but in reality is just a non-serious rash that sometimes occurs with strep throat.

Symptoms of strep throat are sore throat, fever, tender swollen glands in the neck and nausea or stomachache. A white coating in the throat is often a sign of strep but is not fool-proof, because it can also be caused by viruses. There is usually not an associated runny nose or cough with strep throat.

Tonsillitis is an infection of the tonsils, which are the two glands found in your throat on either side of the back of the tongue. Healthy tonsils are usually not visible because they are so small. Tonsillitis is most common in childhood and can be caused either by the strep germ or by a virus. Tonsillectomy (surgical removal of the tonsils), which was done routinely when I was a kid, is now only done in patients with repeated episodes of culture-proven strep tonsillitis.
When you have a sore throat that concerns you, see your health provider, who will listen to your symptoms, perform an examination and often order laboratory testing. The tests are usually either a rapid test that is done in the office and takes about 10 minutes or a culture that will be sent out to a lab and takes 24 to 48 hours for the results. The out-of-office culture is usually done when the rapid test is negative, as a further means of ruling out strep as the cause of the sore throat.

The treatment for strep throat is penicillin or its close relative, amoxicillin. Strep is one of the few infections where penicillin is still the best cure; in fact, people will usually feel better within a day or two after beginning treatment. A child being treated for strep can usually return to school within a day or two if there is no fever and if he or she is feeling well enough. A prescription for 10 days is usually given, and it is important to take it to the last pill, even when feeling better. For those allergic to penicillin or amoxicillin, there are several alternatives, such as Keflex or Zithromax.

Strep throat is contagious, but not as much as the common cold. The best way to avoid either condition is to wash your hands regularly, avoid touching your eyes and mouth and keep a distance from those who are coughing or sneezing.
To alleviate the symptoms of a sore throat, I recommend the following:
n Take acetaminophen (Tylenol) or ibuprofen (Advil) or naproxen (Aleve).
n Gargle with warm salt water (1 teaspoon of salt per 6- to 8-ounce glass of water).

  • Suck on throat lozenges, such as Chloraseptic or Cepacol.
  • Suck on flavored frozen treats, such as popsicles, or just plain ice cubes.

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Over-the-counter cough and cold medications to alleviate cold symptoms in young children are being withdrawn from pharmacy shelves. This is because of unintentional misuse or of overdose of these medications, causing harm and, rarely, death, especially in children younger than 2.

These medications are frequently used in good faith, even though there is no scientific proof that these drugs are actually effective. This is a case where the risks outweigh the benefits.

Health care providers are now asked to advise not using these drugs for children younger than 6. Some of the most commonly used drugs in this category are PediaCare, Triaminic and Dimetapp.

I know this may sound discouraging when caring for a sick child, but there are very useful non-drug treatments for cold and cough symptoms:

  • Encourage the child to drink plenty of fluids to prevent dehydration and to help thin out mucus. Contrary to popular opinion, milk has not been proven to increase mucus. The fat in milk does combine with saliva in the mouth, causing a slimy sensation, but that’s not harmful.
  • Fever or pain can be controlled using either acetaminophen (Tylenol) or ibuprofen (Advil), giving accurate and consistent doses every six hours.
  • Saline irrigations: For infants, use rubber bulb suction with saline nose drops to remove mucus. A saline nose spray can be used for older children.
  • Use a cool-mist humidifier or vaporizer in the child’s room. To prevent contamination, the water should be replaced daily and the machine cleansed regularly according to the manufacturer’s recommendations. Keep indoor relative humidity at about 40 percent to 50 percent
  • If a medication such as Tylenol or Advil is given, I do not advise the use of household silverware spoons to measure doses of medication. Common teaspoons can vary, holding anywhere from 2 to 10 milliliters (mLs) of liquid, which could cause either an under- or overdose of a medication. Proper measuring devices using units of milliliters usually come with the medicine or can be obtained from the pharmacist.
  • Honey can relieve coughs by increasing saliva, which coats the throat and relieves irritation. Suggested doses are half a teaspoon for children between 1 and 5 years, 1 teaspoon for children 6 to 11 years, and 2 teaspoons for children 12 years and older. Do not give honey to a child younger than 1 year old.

See your health care provider immediately for any of the following cases:

  • A child younger than 2 months of age with any fever
  • A child younger than 2 years with a fever that lasts longer than two or three days
  • A child who complains of an earache or a severe sore throat
  • A child who has thick green nasal discharge for more than 2 weeks
  • Mild symptoms that fail to improve after 10 to 14 days
  • Any child who seems very ill to you

By the way, for children who have been appropriately prescribed antibiotics, I am frequently asked whether the drug needs to be refrigerated. The two most commonly prescribed antibiotics, Amoxicillin (which tastes like bubblegum or occasionally is fruit-flavored) and Zithromax (which has a cherry-vanilla-banana taste), can be kept at room temperature for as long as 10 days. Refrigeration may improve the taste, but it isn’t needed to maintain potency.

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