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Child diagnosed with strep, persisting fever and stomach discomfort inspite of medicines. Concerning?

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Internal Medicine Specialist
Practicing since : 2005
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My 7 yr old son was diagnosed with strep last tuesday (6 days ago). He was put on amoxicillin. He had a very high fever of 104.5 and then the next day of 103. He also has a cough. This many days later he still has a temp of 99.5. Is this concerning. He seems fine, but complaining of a little stomach discomfort and not too hungry.

I feel like other times he has been to the pediatrician, even when he is not sick, his temp is 99 or 99.3. Should I be worried about this??
Posted Sat, 1 Jun 2013 in Medicines and Side Effects
Answered by Dr. Omer 48 minutes later

Thanks for your question. My name is Dr Omer and I am here to help you today with your question. I will be happy to assist you with your follow up questions also. I am sorry to hear about your problem.

As you have told that your son is suffering from streptococcus tonsilltis for 6 days and is being treated with anti streptococcus antibiotics, with still fever persists?.

Symptoms of strep throat, which is very common among kids and teens, include fever, stomach pain, and red, swollen tonsils.
A child with strep throat will start to develop other symptoms within about 3 days, such as:

red and white patches in the throat
difficulty swallowing
tender or swollen glands (lymph nodes) in the neck
red and enlarged tonsils
lower stomach pain
general discomfort, uneasiness, or ill feeling
loss of appetite and nausea

Fever (also known as pyrexia) is one of the most common medical signs and is characterized by an elevation of body temperature above the normal range of (97.7–99.5 °F) so your child having 99/99.3F appears normal temperature.

In healthy adul/childrent men and women, the range of normal, healthy temperatures
for oral temperature is (91.8–100.8 °F)
axillary (the armpit) it is (95.9–98.6 °F).
Harrison's textbook of XXXXXXX medicine defines a fever as a morning temperature (>98.9°F) or an evening temperature of (>99.9°F) while the normal daily temperature variation is typically (0.9°F).

Oral penicillin V is the agent of choice for treatment of GAS(group a sterp) pharyngitis in many clinical settings given its proven efficacy, safety, narrow spectrum, and low cost.

Amoxicillin is often used in place of oral penicillin in children, since the taste of the amoxicillin suspension is more palatable than that of penicillin .

First generation cephalosporins are an acceptable alternative to penicillin and amoxicillin in the setting of treatment failure or beta-lactam hypersensitivity.

Although most patients improve clinically within the first few days of treatment, the conventional duration of oral antibiotic therapy is 10 days to achieve maximal pharyngeal GAS(group a strep) eradication rates.

Patients who are long-term streptococcal carriers may develop multiple episodes of pharyngitis due to viral infection. In such cases, repeatedly positive cultures or rapid antigen tests for GAS may be misleading, and further treatment for streptococcal pharyngitis may not be warranted. Carriers are unlikely to spread the organism to close contacts and are at very low risk for developing suppurative complications or acute rheumatic fever. Moreover, eradication of GAS from the upper respiratory tract of carriers can be difficult and is not necessary.

The nonsuppurative complications of GAS tonsillopharyngitis include when 10 days treatment of strep is not completed or recurrent infection of strep:

Acute rheumatic fever
Scarlet fever
Streptococcal toxic shock syndrome
Acute glomerulonephritis
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder associated with group A Streptococci)

I have few question:
1 what type of strep he is suffering from, check reports(A,B,C,D,G)
2.Check armpit temperature morning and evening
3.does he have recurrent strep infections

Your child is improving with amoxicillin, continue it for 10 days, his temperature 99.3 is normal and his appetite will approve in few days as well as the stomach pain.....nothing to worry about as i have told you in detail above.

I wish you good luck that you get well soon, if you have any question, please ask because our discussion always remains open so you can always ask more till you are satisfied, You can click the smiley to rate the answer. You can come back here to ask anything even after you have rated the answer. I will be glad to assist you always.
take care
Above answer was peer-reviewed by
Follow-up: Child diagnosed with strep, persisting fever and stomach discomfort inspite of medicines. Concerning? 49 minutes later
Thank you for your reply. I do not know which type of strep as he had a rapid strep test in the office.

The other symptom he had started two days ago which was bad pain in his calfs and he could only walk on his toes. His pediatrician said this is seen with strep and should resolve within a few days w ibuprofen. He seems to be better and walking better, yet still has some discomfort.

Should I worry about the times he has been to the doctor, while not sick, and his temp was 99+?
Answered by Dr. Omer 34 minutes later
Hello again,

As you don't know the type than mostly it is GAS( group A strep), whose details I have already explained it to you.

Pain in calf is common in GAS but keep on observing your child for any neuropsychiatric disorder or hyperactivity disorder, other wise your doctor is saying the same that it will go away after complete treatment of strep.Calf pain is common in strep infection.

As I have told you temperature variation of 99-99.9 is taken normal, and does not show any infection, I have discussed it in detail in last reply.Take the temperature in morning and evening armpit and you will get relax as it will be normal, as discussed in last reply.

Just try to calm your self, looks like its your only child, children get sick all the time but get better as there immune system gets improved with every infection.

Take care

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