my 6 yr old daughter has been treated for strep on 5-12, 4-20, 3-31,3-22-97 with kefex, cefzil, zithromax, keflex,and still has strep. by taking the tonsil out will this go away? and why wont it go away?im very scard cause i understand strep can be very dangerous. please help me to understand all this. what can i do for her?

Reply: -------------------------- It is important to know how your child has been tested. When you state that your child still has strep, how has this been demonstrated? Has she had a culture after each antibiotic that has repeatedly shown strep bacteria? Or has she simply had a "strep screen"? Rapid strep screening tests are useful as initial tests in the evaluation of a sore throat. However, problematic sore throats warrant actual cultures of the throat and if the cultures are positive, antibiotic sensitivity studies should be done on the culture. It is increasingly common to identify resistant streptococcal bacteria - often the bacteria is resistant mainly to pencillin and second or third generation cephalosporins or macrolides will work. Culture and sensitivities should guide antibiotic therapy in your child's situation - if a culture and sensitivity suggests that the strep is sensitive to a certain antibiotic, but repeat cultures show the strep still present after an appropriate 10 day course of that antibiotic, then I would suggest 2 possible alternatives: 1) longer term antibiotic therapy (several weeks),intravenous antibiotic therapy, or multiple drug therapy with consultation from an infectious disease specialist, or 2) consideration of adenotonsillectomy. A complete assessment of the child and past medical history would be necessary to help determine which alternative might offer the best potential risk/benefit profile for an individual patient. If you have not already done so, I would suggest a consultation with an otolaryngologist.

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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis

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