What You Need to Know About Angina and Lack of Amoxicillin

You or your children may already be familiar with angina; I know that as a child I had to suffer from many throat swabs and pink liquid medicines. But drugs to treat it are now in short supply, and the CDC recently warned that they are seeing a surge in cases of more severe forms of group A streptococcus. Here’s what it all means.

What is streptococcus?

“Streptococcus” is a nickname for two different types of bacteria. Streptococcus pyogenes is known as group A streptococcus and is the one that causes strep throat. (“Streptococcus” refers to the shape of a chain, and “coccus” refers to the shape of a ball, because these bacteria look like a chain of small balls under a microscope.)

Group A Streptococcus is responsible for:

• Streptococcal angina
• Scarlet fever (also called scarlet fever)
• Impetigo, skin infection
• rheumatic fever
• Some types of toxic shock syndrome, cellulitis, and necrotizing fasciitis

In contrast, group B streptococcus is another species best known for causing serious infections in newborns who pick up the bacteria during birth .

What are the symptoms of angina?

Typical symptoms of acute pharyngitis are sore throat and fever. Scarlet fever is similar but also includes a rash. And while “scarlet fever” sounds like something out of a Dickens novel, it’s still fairly common these days among kids ages 5 to 15. Fortunately, it is treatable.

Signs of strep throat include a red throat, white spots on swollen tonsils, and small red spots called petechiae on the palate. The CDC has graphics and more information here . Streptococcal tonsillitis is usually not accompanied by a cough or runny nose.

Scarlet fever also tends to be accompanied by redness and sore throat, and the child may have a whitish coating on the tongue that progresses to a bumpy “strawberry” appearance. Often in the folds of the skin, such as in the armpits, there is a red rash that resembles sandpaper.

Impetigo is a skin condition that can be caused by group A streptococcus or another type of bacteria ( Staphylococcus aureus ). Its telltale sign is red itchy sores with yellow scabs either around the mouth or on the arms and legs.

Streptococcal tonsillitis and scarlet fever can be spread through the air (for example, by coughing or sneezing, or by very close contact with a sick person). Impetigo can be spread by touching sores.

Invasive streptococcal infections are on the rise

The infections mentioned above are usually not serious if treated quickly. If you think your child has one of these infections, seek medical attention and get antibiotics. (Adults can also get these infections, so be sure to check yourself if necessary.)

Without treatment, they can progress to more serious illnesses. The CDC recently warned doctors and parents about “invasive group A streptococcal disease,” in which germs enter parts of the body that would not normally come into contact with the bacteria at all. They can be very serious and even life-threatening. These invasive diseases include necrotizing fasciitis (sometimes known as “flesh-eating bacteria”) and a streptococcal version of toxic shock syndrome.

The CDC recommends promptly treating mild cases of strep and reducing the risk of invasive disease by keeping flu and varicella vaccines up to date. The flu and chickenpox make you more susceptible to invasive infections.

How is streptococcus treated?

Unlike the common cold and flu , streptococcus is one of the most common illnesses that can be successfully treated with antibiotics. For young children, one of the most common medications is a liquid amoxicillin preparation. (This is what almost looks like a strawberry milkshake.)

Pharmacies currently lack the powder that is used to mix this liquid medicine. If you’ve been prescribed it and the pharmacy doesn’t have it, ask your pediatrician for alternatives. In general , there is no shortage of amoxicillin, only its usual preparation.

The American Association of Pediatricians has a page for doctors about what medications they can order instead of regular fluids. Capsules, tablets and chewables are available. Children who cannot take them can take them if crushed and mixed with a liquid or food, such as applesauce. If amoxicillin is not available, other antibiotics may be suitable.