The dreaded “Strep Throat” is a real problem that may is rare circumstances lead to secondary complications.  Althought these are much less likely in our day of routine antibiotics, they are still possibilities and are a valid reason to correctly diagnose and treat.

“Don’t go looking to hard for problems”.  If someone is asymptomatic, they probably are not contageous and do not warrant treatment.  It is estimated that up to 10% of us may be carrying the bacteria.  If you are concerned then checking ASO Titers may be a way to determine if treatment is warranted.

If the patient has a symptomatic pharyngitis, then a rapid strep test is the best and most cost effective way to go.  Even with that is still costs almost 800k to prevent a single case of Rheumatic Heart Disease.  There is little concensus on wheather or not Post Strep Glomerular Nephritis can even be prevented.  PANDAs and the like might also benefit from treating.

If you are presented with a repeat offender, the treatment you are using might actually be part of the problem. It is felt that the repeated use of PCN type antibiotics might actually kill off the normal flora, leaveng a predominance of Penicillinase producers giving relative protection to the GABHS.  A better option may be Clindamycin (Cleocin) 20 mg/kg/day given tid for 10 days.  Ceftibutin (Cedax) is another option.  You may not be a hero on taste. Painting the tonsils with Argyrol might be a distant option. It is a 10 % stabiled Silver Proteinate solution, by can cause a rare complication of Argyria.

Patients and family members should all wash the tooth brushes in the top shelf on day 1 5 and 10 of treatment.  Treating the family is probably not necessary, nor is treating the dog.  These options can be considered, however in difficult circumstances. Adults can keep their tooth brushes in a nice brandy.