One of the frequently encountered infections, especially in children, and during winter time is tonsillitis , also called pharyngitis. Most of the symptoms are caused by viruses, which usually do not require an antibiotic treatment (you should know that antibiotics are ineffective against viruses, only against bacteria), and only will need only symptomatic treatment with fluids and antipyretics. Only a quarter of clinical referrals are caused by bacterial infections, the later being caused by viruses.
The problem is that the symptoms produced by viral infections are very similar to those caused by bacteria, which in practice means it is very difficult to distinguish between the two after examining the patient and evaluating his amigdalitis signs and symptoms . This leads to the fear that the symptoms are produced by bacteria, and many families put pressure on family doctors and pediatricians to prescribe antibiotics to the sick patient, raising the risk that other germs to develop resistance to antibiotics.
The most feared bacteria may be present in these tables is the GABHS A (group A beta-hemolytic streptococcus), which is responsible for more severe infections. Fortunately diagnostic tests that allow rapid and early diagnosis of streptococcal infections are available, easy and safe to use. If these tests are negative, with a reliability close to 98%, the symptoms are not caused by a streptococcus, which avoids having to take antibiotics unnecessarily.
The test is conducted by collecting a sample of exudate present in the tonsils or rear region of the pharynx, using a swab (cotton ball wrapped in sterile gauze, which is placed on the end of a stick) with which the area is rubbed and subsequently introduced into a solution prepared for the test. Once mixed with the solution, a test strip is introduced that reads the results in minutes (from 1 ‘to 5’).
The ease of this test is that it can be done in the pediatrician’s own GP or without a sophisticated apparatus, and also it is a painless test.
The test result can not be accurate, and thus give a false negative if antibiotic treatment has been taken previously. Extra care must also be taken that the sample is not contaminated by contact with other areas of the mouth when removing the swab (eg, teeth). It must not be performed in patients who present no clinical data to guide towards streptococcal pharyngitis or tonsillitis.
Clinical data that guide (though not 100%) are the presence of high fever, absence of cough (most likely atypical cold – upper respiratory tract viral infection), presence of swollen glands, and especially a white exudate on the tonsils observed during pharynx examination.