Sore Throat: When Are Antibiotics Needed and When Not?


07. 06. 2018

Some children are prone to suffer from a summer sore throat while others are only affected by it once every couple of years. Sore throat pastilles or a compress can ease the pain, but sometimes antibiotics are required instead. Therefore, when the condition worsens and a fever is present, it is definitely best to visit a pediatrician.

Once a child starts complaining about a sore throat, it is always very important to determine whether it is an infectious disease, what the symptoms are and when the problems started occurring. It is also important to find out whether the problems occurred suddenly or over a longer period of time, gradually. Sometimes, a sore throat can be caused by an allergic reaction which is something that people are often not aware of. It is primarily accompanied by a scratching sensation and can be one of the telltale symptoms of these complications – for example when consuming food which a person could eat without earlier problems. 

Viruses versus bacteria

If a doctor concludes that an infection is behind the problems, it is important to distinguish whether the complications are caused by a bacteria or a virus. Viral complications can be treated by targeting the symptoms while bacterial infections often require antibiotics.

The decision itself may not always be simple even for a very experienced medical professional. Fortunately however, there are a number of criteria which can be followed: when a child has fever, enlarged lymph nodes, does not feel well and the pain is significant, it is likely to be bacterial in nature and antibiotics may be needed. Sometimes, a swab may be administered to rule out the possibility of the antibiotics being prescribed unnecessarily. When streptococcus is detected, it is likely a common case of tonsillitis.

CRP testing of a small sample of blood from the finger of the child may be helpful. However, sometimes when the onset of a bacterial infection is localized, the indicator values gathered from this examination may not be high enough to paint a clear picture. Despite this however, it may be suitable and appropriate to prescribe antibiotics. 

Further, it is possible that someone suffers from sore throat only and does not suffer from any other associated symptoms. After a streptococcus test which can be carried out quickly at our clinic, the patient may find that he/she suffers from a streptococcal infection. This can further be confirmed when a swab is carried out and the bacterial sample cultivated.

The summer can bring painful herpetic angina

A sore throat is also associated with a wide range of viral infections including those of a herpetic nature. It can appear to be a case of tonsillitis, but if we notice small blisters at the roof of our mouth, it is likely to be herpetic angina. It hurts significantly and causes difficulties while swallowing, often resulting in the child not wanting to eat and drink. There is no direct treatment available. As a result of this disease, a child can end up with infusions at the hospital. This is because it is otherwise difficult to hydrate the child and to ensure a sufficient intake of calories. During summer months, it is not uncommon to come across this disease.

Here, a CRP examination from a sample of blood from the finger may be very helpful.  Despite strong symptoms and pain, a low CRP may indicate that it is not a bacterial infection.

Blisters in the mouth as well as on the palms and soles are a different disease altogether. These are the tell-tale symptoms of the hand, foot and mouth disease. It is nothing serious in nature and usually affects preschool children. It spreads easily and the symptoms usually disappear only within a couple days without the need for any treatment. 

Ice-cream does not cause tonsillitis unless a child is prone to suffer from the disease

A common sore throat can be treated at home based on the family preference of treatment. Some prefer tablets or sprays from the pharmacy while others opt for gargling, a Priessnitz compress of the neck or drinking sage.

Ice-cream does not cause tonsillitis in the same way as someone does not get a cold just because he/she did not wear enough clothes when it was cold outside. It can however aid in progressing the disease in case the child had a weakened immune system or is prone to suffer from a sore throat. A neck exposed to the cold can then have difficulty protecting itself from infections caused by bacteria and viruses which can multiply easier.

What you need to know about bacterial tonsillitis:

  • It is an inflammatory disease of the tonsils caused by bacteria.
  • Streptococcus is a common culprit of tonsillitis.
  • It is passed on by droplets in the air even when the person is not sneezing. The incubation period can be up to three days.
  • Aside from the sore throat making it difficult to swallow, it is also manifested through enlarged lymph nodes, a higher body temperature, abdominal pain as well as general fatigue.
  • The most effective treatment involves antibiotics and sufficient rest in the bed.

In comparison, a viral sore throat:

  • Can be caused by a set of multiple agents.
  • Can be the painful form of herpetic angina as well as common cold manifesting itself through soreness rather than pain when swallowing.
  • Can be mononucleosis which is usually passed on by kissing and which is typically associated with enlarged tonsils.
  • There is no direct treatment available. Only the symptoms are treated and their impact minimized. In the case of mononucleosis and based on its severity, patients need to adhere to a strict liver diet.
  • The incubation period depends on the type of virus, but is generally very similar to the incubation period of bacterial tonsillitis.

Barbara Taušová – a specialist pediatrician. Founder, CEO and director of Canadian Medicaldirector of the Pediatric Outpatient Center for Children.


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