Why strep afflicts some children repeatedly is a question under scrutiny in the medical community, since this infectious disease is potentially dangerous. It can lead to rheumatic fever within two weeks if left untreated. In underdeveloped countries and in countries where health care is not readily available, the mortality rate from strep equals that of tuberculosis: three to four million children a year.

Most susceptible to strep are children between 4 and 15 years of age, although older and younger family members can become infected as the illness "makes the rounds" within the household. The infection is identified by a throat culture to confirm the presence of strep bacteria, with test results within 48 hours.

Why Does Strep Recur?

Attack of the Bandit Bacteria. More than one strain of strep often is present in the throat of the infected child. It is an active primary strain of strep that causes the symptoms, which in turn cause the body's immune system to fight the infection. But the throat may also contain dormant strains of "bandit bacteria" that are resistant to the medications that fight the active strain of strep. Although a child may recover from the initial strep infection, the bandit bacteria lie ready to attack.

Interruption of Treatment. In cases where bandit bacteria are not the cause of recurrent strep infections, failure to follow the prescribed treatment may be the reason for recurrence. A recent study found that two-thirds of parents stop administering medication as soon as a child's symptoms abate or disappear contributing to the return of the infection. It is essential that medication be given without interruption for a full 10 days, even if symptoms have disappeared. Most physicians regard a 10-day regimen of penicillin as the most appropriate treatment for most strep infections.

All in the Family. Even with treatment, strep can have a "domino effect," falling one member of the family after the other, and even eventually returning to the child who had the initial infection. A recent article in the New York Times suggested that one overlooked culprit may be the family dog, since dogs can harbor strep bacteria in their bodies. A trip to the vet may be indicated if you have a dog and your family is suffering with recurrent strep.

Resistance to Penicillin. There are, or soon will be strains of strep that are resistant to penicillin. Alternative antibiotics will have to be administered.

Silent Carriers. Where strep occurs in only one or a few family members, doctors often recommend that throat cultures be taken of everyone in the family, since some human carriers of strep never exhibit strep symptoms.

Reviewed 2-17-03