Does your child need antibiotics for their sore throat this winter?

The cold weather has certainly arrived in full force this year and so I thought it may be a good time to talk about one of the most common illnesses our children experience over winter – a sore throat! For many of us this means a miserable child who won’t eat or drink, time off kinder or school and time off work for the weary parents. I know I have had to take a day off work when one of my kids has been sick quite a few times.

Here at the RCH Emergency Department (ED), we see so many families who have brought in their kids because they have a sore throat. Because our ED treats patients in order of medical urgency, children with sore throats often wait a very long time to be seen, sometimes six hours or more, only to be told that the child doesn’t need antibiotics and should return home.

So when you are sitting up in the middle of the night with a sick child, like I have done many times, wondering whether or not to take them to the ED or your GP, I thought it may be useful to understand what factors are considered by the doctor when deciding whether or not to give antibiotics.

What causes sore throats?

Viruses or bacteria can cause sore throats. Viruses cause about 90 per cent of sore throats and streptococcus (strep), the commonest bacterial cause, accounts for about 10 per cent of sore throat cases in children.

Antibiotics only treat bacterial causes of sore throat and so you can see that, most of the time, your child won’t need antibiotics, as the cause of their sore throat is more likely to be viral.

How does the doctor tell the difference between a viral and bacterial infection?

If your child has symptoms of a cold, such as a runny nose and a cough, they most likely have a viral infection causing their sore throat. Symptoms such as high fever, razor sharp sore throat, abdominal pain and vomiting are more suggestive of a bacterial cause.

It is very difficult for doctors to be able to accurately tell the difference between a viral or bacterial cause of sore throat by simply examining your child. So, a throat swab can be done to detect strep throat. We recommend a throat swab if antibiotics are being considered.

In most cases, if the throat swab is positive for strep, your doctor will give your child antibiotics, usually penicillin. As it takes a day or so for the throat swab result to come back, your doctor may decide to start antibiotics straight away if your child is quite unwell and then ask you to stop them if the throat swab is negative. Antibiotics help to resolve the symptoms faster, prevent complications of strep throat (such as a throat abscess) and prevent transmission of the bug to other family members.

What can you do to relieve your child’s pain?

Both paracetamol (eg. Panadol) and ibuprofen (eg. Nurofen) can be given for pain relief. Paracetamol can be given every four hours and ibuprofen every six hours, so you can alternate them if your child’s pain is particularly bad. Ibuprofen is especially good at night for pain as it may help your child sleep better for longer. Sometimes throat washes and gargles can also help if your child is old enough to use them.

If a virus is causing your child’s sore throat, just use analgesics and throat gargles. Antibiotics will not help and should not be used. It is important to know that treating a viral sore throat or any other viral infection with antibiotics contributes to the development of bacteria in the body that can become resistant to antibiotics. That is, bugs that are no longer killed by the antibiotics doctors would normally prescribe, also known as “superbugs”. If a person develops a resistance to certain antibiotics, doctors are forced to prescribe stronger, more expensive antibiotics because the common ones would not be effective any more, which can be a very serious problem.

If your child is having recurrent episodes of sore throat you should consider seeing an Ear Nose and Throat (ENT) doctor to determine whether they need their tonsils removed, especially if they are having multiple episodes of strep throat confirmed on throat swab.

So, as you can see, your doctor is weighing up many factors when deciding whether or not to prescribe antibiotics for your child’s sore throat. Viruses can make kids just as sick but unfortunately antibiotics won’t help. Hopefully the sore throats will stay at bay in your family this winter!