Strep Throat Diagnosis & Treatment

By Frederick Hecht, M.D. and Barbara K. Hecht, Ph.D.
Medical Authors and Editors,

Sore Throat

Most sore throats (pharyngitis) are viral and will not respond to antibiotics. Bacterial causes of sore throat include group A streptococcus. The complications of strep throat include rheumatic fever, ear infections, mastoiditis, sinusitis, peritonsillar abscess, glomerulonephritis (a kidney disorder), and scarlet fever.

The medical challenges presented by a sore throat are not to treat the many that are viral, but to find the few that are strep throats and treat them promptly and effectively.

Diagnosis of Strep Throat

When a child has a sore throat, a rapid antigen test should be done for strep, according to Dr. Warren J. McIsaac and colleagues in Canada. If the rapid test is positive, the child (or adult) should be treated with an antibiotic. If the rapid test is negative, a throat culture may be done. (This takes more time, usually overnight.)  

Treatment of Strep Throat

The cephalosporin antibiotics such as cephalexin (Keflex, Keftabs, Biocef) and cefadroxil (Duricef) are about three times more effective -- three times  less likely to fail -- in eradicating strep than penicillin. This conclusion is based on a meta-analysis of 35 trials reported by Drs. Janet R. Casey and Michael E. Pichichero from the University of Rochester.


  1. Warren J. McIsaac; James D. Kellner; Peggy Aufricht; Anita Vanjaka; Donald E. Low. Empirical Validation of Guidelines for the Management of Pharyngitis in Children and Adults. JAMA. 2004; 291:1587-1595.
  2. Janet R. Casey; Michael E. Pichichero. Meta-analysis of Cephalosporin Versus Penicillin Treatment of Group A Streptococcal Tonsillopharyngitis in Children PEDIATRICS 2004; 113: 866-882

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