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But the reason we treat Strep is to prevent rheumatic fever. Children this
age don't get RF. Data on symptom resolution suggests a minimally faster
improvement if treated. So why expose all these kids to antibiotics?

Kevin Powell <[log in to unmask]> wrote:

Along with the Red Book information cited by others, may I add 3 articles
from Clinical Pediatrics, July/August 1999

http://cpj.sagepub.com/cgi/content/abstract/38/6/357 states that:
The incidence of both true infection and carrier state gradually increased
with age. Nevertheless, true streptococcal pharyngitis was found even in
patients younger than 1 year and its percentage related to carriers did
not
increase with age and was ?50% in all age groups up to 4 years. The
authors
conclude that true GABHS pharyngitis may present in the first year of
life.

and

http://cpj.sagepub.com/cgi/reprint/38/6/361
is entitled
Group A Streptococcal Pharyngotonsillitis in Children Less Than 2 Years of
Age More Common Than is Thought

So to answer Fred's questions, based on these articles, Group A strep in
toddlers is a real URI. It is not as easily recognized because the tonsils
early on don't look like those of older kids -- often just purulent
rhinitis. It is not just a carrier state. The idea that toddlers can't get
strep is outdated by over 10 years. In my clinic, I haven't tested for it
often or routinely, but I treat it when found.

Kevin Powell MD PhD FAAP
SSM Cardinal Glennon Children's Medical Center
Associate Professor of Pediatrics
Saint Louis University




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