Next-Day Return to School with Strep Pharyngitis

Summary and Comment |
September 25, 2015

Next-Day Return to School with Strep Pharyngitis

  1. Cornelius W. Van Niel, MD

Waiting 24 hours after treatment starts is the current recommendation, but just 12 hours might be enough.

  1. Cornelius W. Van Niel, MD

Current guidelines recommend at least 24 hours of exclusion from school for children treated with antibiotics for streptococcal pharyngitis, even though prior studies suggest 18 hours may be enough. In a study at a single private pediatric practice, 111 children (age range, 2 to 17 years) with positive streptococcal rapid antigen detection tests and positive group A streptococcal cultures were given a dose of amoxicillin (50 mg/kg) and retested 12 to 23 hours later (the next morning).

Only 10 children (9%) had a positive rapid test or culture the next morning. The proportion of “treatment failures” did not vary significantly by the length of time since the first amoxicillin dose or whether children were given the day-2 dose of amoxicillin before they came to the clinic for retesting. Only two children had persistently high group A beta-hemolytic streptococcus colony counts on their second throat culture (reported semi-quantitatively as 3+ or 4+).


This is good news for children who want to return to school or childcare the morning after streptococcal pharyngitis treatment and for parents and caregivers who need to get back to work. Only 2% of children had persistently heavy culture growth, which is presumably correlated with clinical infectiousness. Given that only about a quarter of children were retested 12 to 17 hours after treatment, a larger sample would reassure me that the findings hold for children diagnosed and treated in the afternoon. This study applies to a once-daily amoxicillin 50 mg/kg regimen, which I don't always prescribe; intramuscular penicillin is an option I often recommend for reasons of compliance and convenience. However, now I will consider it my first line if next-day childcare is an issue. As the authors note, children should also be afebrile and feeling better before returning to school.

Editor Disclosures at Time of Publication

  • Disclosures for Cornelius W. Van Niel, MD at time of publication Equity Medtronic; Express Scripts; Johnson & Johnson; Merck


Reader Comments (2)


That would certainly be good to know but may require a separate study of that particular treatment.

ALIREZA HEJRATI Physician, Internal Medicine, IUMS

Is this true in children treated by single dose of intramuscular penicillin G benzatin?

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