How long does fever last with strep after antibiotics

Strep throat symptoms.

Strep throat, a bacterial infection in the throat and tonsils, causes a sore or scratchy throat, as well as white patches on your tonsils.

It is highly contagious during the incubation period — the two to five days after you’re infected and before symptoms appear – and stays contagious until your symptoms resolve, according to Jake Mefford, PA, clinical director for OSF OnCall Urgent Care clinics.

“Hand hygiene and disinfecting commonly used surfaces frequently can decrease the risk of transmission of strep,” Jake said.

Jake took time to answer more questions about strep:

A. Strep throat refers to the inflammation of the pharynx (pharyngitis), and/or tonsils (tonsillitis) caused by a group A streptococcus infection, This is just one of the many types of streptococcus bacteria.

Q. What does strep look like?

A. Common findings of the throat include redness, swelling and exudates (white patches).

Q. What are symptoms of strep?

A. In addition to a sore throat, someone with strep may experience a fever, headache, abdominal pain, nausea, vomiting, enlarged lymph nodes and rash.

Q. How is strep diagnosed?

A. The tonsils are examined and a sample of fluid may be taken from the back of the throat using a soft swab. The sample can be checked right away for the bacteria that cause strep throat. If the initial test is negative, the sample may be sent to a lab for further testing with a culture.

Q. How long does strep last?

A. Strep throat typically resolves in three to five days if untreated. Despite the short duration, antibiotic treatment is recommended to reduce the risk of complications. Symptoms typically resolve within one to three days following the start of antibiotics.

Q. How is strep spread?

A. Strep throat is transmitted via droplets. These can be tiny airborne droplets after a cough or sneeze or from surfaces that are contaminated with droplets.

Q. How is it different than a regular sore throat?

A. There are many different types of bacteria and viruses that can cause a sore throat. Many of the symptoms overlap between the causative agents and therefore it is very difficult to differentiate between strep pharyngitis and other causes of pharyngitis without testing. A cough is not a common symptom with strep throat and may indicate a different cause of sore throat.

Q. How should strep be treated?

A. Ibuprofen and acetaminophen can be used for discomfort and fever. Stay hydrated, rest and maintain a soft diet for comfort.

Q. Are antibiotics used to treat strep?

A. Antibiotics are used with the following goals in mind: reduce the severity and duration of symptoms, prevent acute and delayed complications and prevent the spread to others.

A. Most cases of strep throat resolve without complications. However, complications can include blood stream bacterial infections, abscesses in the tissue surrounding the throat, ear infections and sinus infections. Other complications following the initial strep throat infection include acute rheumatic fever, kidney issues and psychiatric disorders.

Q. Is medical attention always needed for strep?

A. If strep pharyngitis is suspected, a strep test is recommended.

Q. Are there home remedies that can be used to treat strep?

A. In addition to a soft diet to avoid irritating the throat, individuals with strep may find the following soothing:

Cold or warm beverages (honey should not be given to children less than 1 year old)
Cold or frozen desserts such as popsicles, sucking on ice, sucking on hard candy (not recommended for children under 5 years old)
Gargling warm salt water (1/2 teaspoon per 8 ounces of water)

Pharyngitis - streptococcal; Streptococcal pharyngitis; Tonsillitis - strep; Sore throat strep

Strep throat is a disease that causes a sore throat (pharyngitis). It is an infection with a germ called group A streptococcus bacteria.

Sometimes when you have a sore throat, it's more than just a normal cold, especially if your throat feels raw or like it's on fire. Most people get sore throats from a viral infection, in other words, the common cold. But, occasionally, you might come down with strep throat, which is caused by a type of bacteria called Streptococcus pyogenes. These bacteria are contagious. Like with germs that cause a cold, you can also get strep throat from handling a doorknob or other surface, then touching your nose or mouth. How do you know for sure that you have strep throat? You may start to feel sick a few days after you come into contact with the bacteria that causes strep throat, but usually people will start feeling sick suddenly. You will probably have a fever very quickly, and your throat will be very sore. If you look in a mirror, the back of your throat may be very red, and you might see white patches on your tonsils. You may also have a headache, be sick to your stomach, and feel chills. Your doctor will check your throat for redness, swelling, and white patches, then rub a sterile swab over your tonsils, taking a sample of mucous. A rapid antigen test done at your doctor's office can find bacteria from the swab in minutes, so you can find out if strep throat is causing your symptoms. Your doctor will probably send the swab to a laboratory to double check your diagnosis, but this test may take a day or two. There's another common type of bacteria that can cause throat infections, especially in young adults; The bacteria's name is Fusobacterium necrophorum. I call it F-throat. Antibiotics are important for F-throat. It doesn't show up on strep tests, so it's important to keep in mind with severe sore throats or sore throats that aren't getting better as expected. Since strep does NOT cause most sore throats, your doctor will make sure you have it before treating you for it. If you do, your doctor will most likely ask you to take penicillin or amoxicillin for 10 days, even though you might feel much better after a few days. The reason is because strep throat can sometimes lead to more serious health problems, such as rheumatic fever. Be sure to tell your doctor if you're allergic to some antibiotics, so you can receive a different medication. While you wait for the antibiotics to start fighting the infection, you can follow these tips to help your throat feel better; Drink warm liquids like tea with honey; Gargle several times a day with a teaspoon of salt in a cup of warm water; Drink cold liquids, or suck on popsicles, hard candies, or throat lozenges; Keep a vaporizer or humidifier running in your room to soothe the dryness in your throat AND Take over-the-counter pain medicines. It's important to see your doctor if you think you have strep throat, because, untreated, it can lead to very serious health problems. Once you start treatment, your symptoms will probably be gone in about a week. But if you don't start feeling in a day or two, make sure you call your doctor.

Structures of the throat include the esophagus, trachea, epiglottis and tonsils.

Strep throat is the most common bacterial cause of sore throat. Because strep throat can occasionally lead to rheumatic fever, antibiotics are given. Strep throat often includes a fever (greater than 101 degrees Fahrenheit or 38.3 degrees Centigrade), white draining patches on the throat, and swollen or tender lymph glands in the neck. Children may have headache and stomach pain.

A throat swab can be used to determine if Group A Streptococcus bacteria is the cause of pharyngitis in a patient.

Causes

Strep throat is most common in children between ages 5 and 15, although anyone can get it.

Strep throat is spread by person-to-person contact with fluids from the nose or saliva. It commonly spreads among family or household members.

Symptoms

Symptoms appear about 2 to 5 days after coming in contact with the strep germ. They may be mild or severe.

Common symptoms include:

Fever that may begin suddenly and is often the highest on the second day
Chills
Red, sore throat that may have white patches
Pain when swallowing
Swollen, tender neck glands

Other symptoms may include:

General ill feeling
A loss of appetite and abnormal sense of taste
Headache
Nausea

Some strains of strep throat can lead to a scarlet fever-like rash. The rash first appears on the neck and chest. It may then spread over the body. The rash may feel rough like sandpaper.

The same germ that causes strep throat may also cause symptoms of a sinus infection or an ear infection.

Exams and Tests

Many other causes of sore throat may have the same symptoms. Your health care provider must do a test to diagnose strep throat and decide whether to prescribe antibiotics.

A rapid strep test can be done in most provider offices. However, the test may be negative, even if strep is present.

If the rapid strep test is negative and your provider still suspects that the strep bacteria is causing the sore throat, a throat swab can be tested (cultured) to see if strep grows from it. Results will take 1 to 2 days.

Treatment

Most sore throats are caused by viruses, not bacteria.

A sore throat should be treated with antibiotics only if the strep test is positive. Antibiotics are taken to prevent rare but more serious health problems, such as rheumatic fever.

Penicillin or amoxicillin are most often the first drugs to be tried.

Certain other antibiotics may also work against the strep bacteria.
Antibiotics should be taken for 10 days, even though symptoms are often gone within a few days.

The following tips may help your sore throat feel better:

Drink warm liquids, such as lemon tea or tea with honey.
Gargle several times a day with warm salt water (1/2 tsp or 3 grams of salt in 1 cup or 240 milliliters water).
Drink cold liquids or suck on fruit-flavored ice pops.
Suck on hard candies or throat lozenges. Young children should not be given these products because they can choke on them.
A cool-mist vaporizer or humidifier can moisten and soothe a dry and painful throat.
Try over-the-counter pain medicines, such as acetaminophen.

Outlook (Prognosis)

Symptoms of strep throat most often get better in about 1 week. Untreated, strep can lead to serious complications.

Possible Complications

Complications may include:

Kidney disease caused by strep
A skin condition in which small, red, and scaly teardrop-shaped spots appear on the arms, legs, and middle of the body, called guttate psoriasis
Abscess in the area around the tonsils
Rheumatic fever
Scarlet fever

When to Contact a Medical Professional

Contact your provider if you or your child develops the symptoms of strep throat. Also, call if symptoms do not get better within 24 to 48 hours of starting treatment.

Prevention

Most people with strep can spread the infection to others until they have been on antibiotics for 24 to 48 hours. They should stay home from school, daycare, or work until they have been on antibiotics for at least a day.

Get a new toothbrush after 2 or 3 days, but before finishing the antibiotics. Otherwise, the bacteria can live on the toothbrush and reinfect you when the antibiotics are done. Also, keep your family's toothbrushes and utensils separate, unless they have been washed.

If repeated cases of strep still occur in a family, you might check to see if someone is a strep carrier. Carriers have strep in their throats, but the bacteria do not make them sick. Sometimes, treating them can prevent others from getting strep throat.

References

Flores AR, Caserta MT. Pharyngitis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 59.

Harris AM, Hicks LA, Qaseem A; High Value Care Task Force of the American College of Physicians and for the Centers for Disease Control and Prevention. Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016;164(6):425-434. PMID: 26785402 www.ncbi.nlm.nih.gov/pubmed/26785402/.

Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. PMID: 22965026 www.ncbi.nlm.nih.gov/pubmed/22965026/ .

Tanz RR. Acute pharyngitis. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 409.

van Driel ML, De Sutter AI, Habraken H, Thorning S, Christiaens T. Different antibiotic treatments for group A streptococcal pharyngitis. Cochrane Database Syst Rev. 2016;9:CD004406. PMID: 27614728 www.ncbi.nlm.nih.gov/pubmed/27614728/ .

Version Info

Last reviewed on: 7/19/2021

Reviewed by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

How long should you have a fever after starting antibiotics?

If you get a fever while taking an antibiotic, it will likely go away on its own. But, if your fever doesn't go away after 24 to 48 hours, ask your doctor or pharmacist about using over-the-counter pain relievers such as acetaminophen (Tylenol) or ibuprofen (Motrin) to help reduce the fever.

Is it normal to still have a fever after starting antibiotics?

Fevers from bacterial infections go away after 1-3 days of taking the correct antibiotic, but may improve even without it. If your child still has a fever after taking 3 days of antibiotics they should be seen again by their GP.

How long do strep symptoms last after starting antibiotics?

Someone with strep throat should start feeling better in just a day or two after starting antibiotics. Call the doctor if you or your child are not feeling better after taking antibiotics for 48 hours.

Why is my strep throat not getting better with antibiotics?

If strep throat does not improve within two days of beginning treatment, it could indicate the presence of another infection, the spread of the strep bacteria to other areas outside the throat or an inflammatory reaction. GAS may infect the tonsils and sinuses if left untreated.