Sore Throat and Strep Throat Tips from Pediatric Partners

Many parents presume Strep with every sore throat, but in reality only 20-30% of sore throats are bacterial in kids. The large majority (70-80%) are from a virus and do not need an antibiotic. Children under 3 years of age are less likely to get Strep throat, but it is relatively common in school aged children.

In adults the number of sore throats needing antibiotics is even lower - only 5-15%.

Nationwide, 70% of people who go to a medical provider with a sore throat get an antibiotic. This means many are treated unnecessarily. We need to use antibiotics wisely.

Why do we treat Strep throat with antibiotics?

In most cases Strep throat will be handled by the body's immune system over a relatively short time. Without treatment most symptoms go away within a few days. Before antibiotics were available most people with Strep throat got better on their own.

Strep bacteria can affect the heart, joints, skin, and kidneys. 

Rheumatic fever is an inflammatory disease that can affect the heart, joints, skin, and brain. It's thought to be an immune response to an earlier infection, such as strep throat, scarlet fever, or strep skin infections, that aren't treated properly. Symptoms usually start about 2 to 4 weeks after a strep throat infection. To prevent rheumatic fever, treatment should be started within 9 days of symptoms starting.

Unfortunately treatment does not affect the kidney disease that rarely is a complication of Strep throat.

Why do we want to avoid antibiotics if it is a virus?

Antibiotics do not help the body get better or even feel better faster if a virus is causing the symptoms. They simply are ineffective against viruses.

They do carry risks: diarrhea and allergic reactions are two relatively common issues.

Overusing antibiotics leads to bacterial resistance, which means when someone is sick with a bacterial infection, several antibiotics might fail because the bacteria has become a "super bug" and less inappropriate use will cause fewer super bugs.

Mononucleosis is one type of viral infection that can cause sore throat, typically in teens and young adults. See our Mono page for more. 

How can you know when to bring your kids in for evaluation?

Strep throat and viral sore throats have a lot of common symptoms.

Strep throat typically causes a sudden onset of one or more of the following:

• sore throat
• ​fever
• rash
• headache
• abdominal pain
• nausea
• vomiting
• swollen glands
  

*** If there are "cold" symptoms such as runny nose, cough, hoarse voice, diarrhea, or eye discharge, it is more often from a viral upper respiratory tract infection, not a bacterial infection. You can manage these symptoms at home with the Upper Respiratory Tract Infection Tips page. 

Sore Throat or Strep Throat? What You Need to Know

Not all sore throats are strep! Most are caused by viruses, and antibiotics won’t help those. Here's how we decide when and how to test and treat.

✅ How We Diagnose Strep Throat

• Swab First, Then Decide
• We swab the throat and run a rapid strep test. If it’s positive, we treat. If it’s negative, we may send a throat culture (especially in kids and teens) to be sure
• Kids vs. Adults
• Kids and teens: Need a backup throat culture if the rapid test is negative.
• Adults: Usually don’t need a culture unless the provider thinks strep is very likely.
• No Blood Tests for Strep
• Blood tests that check for past strep infections can’t tell if you have it now. These are only used in special cases, not for regular sore throats.
  

🤧 When Not to Test for Strep

• If your sore throat comes with a cough, runny nose, hoarseness, or mouth sores, it's likely a virus—not strep. Testing in these cases may lead to false positives and unnecessary antibiotics.
• Young children under age 3  usually don’t need to be tested for strep because they rarely get complications like rheumatic fever. They might be tested if they’ve been around someone with strep and have symptoms.
  

💊 After the Test: What’s Next?

• No need to retest after treatment unless your provider has a specific reason (like checking for a carrier).
• ​Don’t test or treat family members unless they also have symptoms.
• For example: if your son has strep but your daughter feels fine, she doesn’t need a test or medicine. If she starts showing symptoms, bring her in.
• Treat strep with the right antibiotic, the right way. 
• Most often: Amoxicillin for 10 days.
• If allergic to penicillin: other options like cephalosporin, clindamycin, clarithromycin (10 days), or azithromycin (5 days).
• You can use acetaminophen or ibuprofen for fever or throat pain.
• Never give aspirin to children. Steroids (like prednisone) are not recommended for routine strep throat.
  

🔁 What If It Keeps Coming Back?

• Some people get frequent strep throat because they’re carriers—they carry the bacteria but don’t actually get sick from it. Often, they get repeated viral infections while still carrying strep in their throat.
• ​Strep carriers usually don’t need antibiotics, since they’re not likely to make others sick or develop serious complications.
• Tonsil removal (tonsillectomy) is not recommended just to reduce how often someone gets strep.
  

👍 Summary:

📌 Still have questions? Talk to your provider!

We’re here to help you feel better and avoid unnecessary treatments.