For Recurring Strep, Antibiotics or Surgery?

Girl Having Throat Examined by Doctor. Mother Watches.
Posted 2/5/2013 by Nebraska Medicine

Posted in

In 1952, children stayed healthy by learning to duck and cover, eating broccoli and getting their tonsils out.

A lot has changed since then. Strep or other throat infections are still prevalent among children, but a tonsillectomy (surgical removal of the tonsils) is no longer done without a second thought. Last year, new medical guidelines from the American Academy of Otolaryngology said tonsillectomies should be reserved for serious cases, specifically:

  • Children with more than seven throat infections within a year
  • Children with more than five throat infections each year for two years in a row
  • Children with more than three throat infections each year for three years in a row

"These guidelines change how people perceive tonsillectomies,” said Samuel Pate, MD, Ear, Nose and Throat. “A referral from a primary care provider to an ENT specialist prior to these guidelines may have more frequently resulted in tonsillectomy. The new guidelines will improve the care we provide, while determining who is a good candidate for surgery."

Tonsillectomies are the second most common surgery performed on children in the U.S. More than 400,000 occur each year. The reason to have the surgery is simple: children without tonsils have a much lower chance of becoming infected with strep.

"It’s a very safe surgery, but no surgery is without risks, however small," Pate said. "You should always weigh the benefits versus the risks of surgery."

Risks from surgery could include nausea and vomiting from general anesthesia (being "put to sleep"), bleeding or infection. Antibiotics have proven just as successful as surgery without the risks. While typically very effective for each occurrence of strep, they aren’t a permanent solution. That means parents can be annoyed with the frequent trips to the pediatrician. Whether it’s for convenience or because of a belief rooted in older generations, Pate said some families still approach him with the mindset that taking tonsils out is necessary.

"That’s why it’s important to have this evidence-based guideline to show people," Pate said. "I educate my patients not only on why I’m choosing to proceed with a particular treatment plan, but also on why I’m not doing something else."

Other factors can also influence the decision to opt for surgery. This could include the way children respond to treatment, the severity of the infections and whether they are causing difficulty breathing or swallowing.

"If a child only gets a few throat infections per year, but also has trouble sleeping and snores, a tonsillectomy is probably a good idea," Pate said.

In the end, it's about doing as much as possible to keep children safe and healthy. So while parents of children with recurring strep may now be making more trips to the doctor for antibiotics than in 1952, they'll be doing it based on sound medical evidence.


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