Is antibiotics the best method for curing strep throat and preventing rheumatic fever?

April 5, 2004 -- Parents with a child suffering from strep throat may want to talk to their pediatrician about what's the best cure, according to an analysis published in the April 2004 issue of Pediatrics. Right now, the antibiotic penicillin is considered the gold standard for treating strep throat. In fact, it's been the long-standing guideline of the American Academy of Pediatrics, the American Heart Association, and the World Health Organization.

But a new meta-analysis of 35 studies, involving more than 7,000 children and done since 1969, finds that a newer class of antibiotics called cephalosporins are three times more effective at treating the bacterial infection than penicillin. "Children who have strep throat will have a superior outcome if they receive cephalosporin rather than penicillin," says Dr. Janet Casey, the study's lead author and a University of Rochester Medical Center pediatrician. Casey says the findings indicate that the newer class of drugs has a more impressive bacterial cure rate.

However, the American Academy of Pediatrics (AAP) still recommends penicillin. The main reason for that recommendation is because they know it prevents rheumatic fever, an inflammatory disease which can involve the heart, joints, skin, and brain. "The cause of rheumatic fever is strep throat, but if people are treated with the appropriate antibiotics, you can prevent it," says Dr. Bob Baltimore, Yale University School of Medicine professor and Committee of Infectious Diseases member.

"We have known that for the eradication of strep in the throat, there are antibiotics that are better than penicillin, but they neither make you better faster, nor prove that they prevent rheumatic fever." The AAP's guideline on strep throat can be found in the Red Book, which is published every three years by the AAP based on the recommendations of the Committee on Infectious Diseases. The Red Book can be changed at any time if updates need to be made to physicians, Baltimore says, adding that the committee will take Dr. Casey's analysis "seriously."

Most kids contract strep from other infected kids. The bacteria are transmitted by respiratory secretions on hands, toys, and other objects. The symptoms are white spots on a red throat, fever, difficulty swallowing, and sometimes, swollen glands in the neck.

Parents should call their child's doctor if their little one develops even a mild sore throat and a low-grade fever lasting more than 24 hours. Because of complications that can arise if left untreated, it's essential to call the doctor if you suspect your child may have strep. The doctor will take a throat culture.