ENT  |  Sore Throat Pathway - Consider Stopping Antibiotics


Sore Throat Pathway - Consider Stopping Antibiotics

Consider stopping antibiotics as long as you are confident that the swab was taken correctly and that the result is a reflection of the clinical symptoms/signs in the patient. If you are in doubt about either of these then it is suggested that the course be completed.

Note it is not necessary to take a post-treatment swab. 

Reference New Zealand Guidelines for Rheumatic Fever; 2014 Update; pg43.

Should throat swabs be repeated after antibiotic course has ceased?

This Clinical Question has not been updated from the 2008 Guideline.

A follow-up throat swab following an adequate course of treatment for GAS pharyngitis is not usually recommended. End of treatment swabbing is recommended in the following specific circumstances where the risk of ARF is greatest and therefore treatment of possible re-infection or carriage  either in the index case or contacts can be justified:

The IDSA119 recommends the following patients in special situations be routinely swabbed after completing their antibiotic courses for GAS pharyngitis:

  • Those with a history of ARF.
  • Those who develop GAS pharyngitis during outbreaks of ARF or post streptococcal glomerulonephritis APSGN). Outbreaks of ARF are very unusual  but outbreaks of APSGN are more common. They should be controlled if possible by controlling the spread of GAS.
  • Those who develop GAS pharyngitis during outbreaks in a closed or partially closed community e.g. boarding school, military barracks, prison.
  • Where there is recurrent GAS pharyngitis within families (IDSA evidence level B-III).

The majority of asymptomatic patients who continue to have positive swabs post-antibiotic treatment are carriers.


Last updated : Friday, August 21, 2015
Next review date : Saturday, August 20,2016

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