The “Strep” Holiday Is Over!
It is common practice, found frequently in emergency department discharge instructions and always mandated by school nurses, that a child who is diagnosed with “strep throat” must be treated with antibiotics for 24 hours or more before returning to school. The rationale, although without foundation, is that this will reduce the risk of disease transmission. Even the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) still make this recommendation.
According to the CDC, “people with strep throat should stay home from school or day care until they have taken antibiotics for at least 24 hours.” The AAP states that “children with strep throat also need to be taking an oral antibiotic for 24 hours before they can return [to school].”1
Let’s consider for a moment that a given child actually has pharyngitis or tonsillitis caused by group A beta-hemolytic streptococcus. Is the 24 hour-rule worth following or just pediatric folklore?