Is it okay to return to school the day after 1 strep throat treatment?

An investigation in children treated for sore throat plus a positive streptococcal rapid antigen detection test (RADT) as a well as a positive culture result for group A Streptococcus (GAS) suggests that the answer to this question may well be “yes.” The children, who ranged in age from 2 to 17 years and were patients at a single pediatric practice, were treated with a single dose of oral amoxicillin (50 mg/kg) and then evaluated the next day.

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Investigators divided 111 consecutive study participants, all of whom had a positive RADT and GAS, into 2 groups: 1 group swallowed the initial dose of amoxicillin in the office at the initial visit (as late as 5 pm) and were given a day-2 dose by a parent at least 1 hour before arrival at the office the next day when a repeat throat culture/RADT specimen was taken; the second group received only the day-1 dose of amoxicillin prior to the day-2 office visit and repeat culture/RADT testing.

GAS was undetectable in 91% of children on day 2, whether or not the day-2 dose of amoxicillin was given before arrival at the study site or administered later. Further, in the 9% of children (10 individuals) who did have positive cultures on day 2, the quantity of GAS on culture had markedly decreased in all but 2 (1 from each group). Investigators concluded that “all children treated with amoxicillin for ‘strep throat’ by 5 pm of day 1 may, if afebrile and improved, attend school on day 2” (Schwartz RH, et al. Pediatr Infect Dis J. 2015;34[12]:1302-1304).

Commentary: The AAP Red Book Committee recommends that children with strep pharyngitis “should not return to school or childcare until at least 24 hours after beginning appropriate antimicrobial therapy.” Imagine how many missed child schooldays and parent workdays could be avoided if this study’s results hold up and that recommendation is modified. -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.