Abrupt OCD or Tics After Recurrent Sore Throat: When Should Pediatricians Suspect PANDAS Rather Than Routine GAS Follow-Up?

How do I distinguish a true recurrent GAS infection from chronic streptococcal carriage in a child?

In a child with repeated positive throat tests for Group A Streptococcus (GAS), true recurrent GAS pharyngitis is more likely when each episode has the classic clinical picture of streptococcal pharyngitis and the child shows clear, prompt improvement within about 24–48 hours of appropriate antibiotics. Chronic strepto

At what recurrence frequency should I refer a child with recurrent tonsillitis for tonsillectomy?

Refer when a child meets the Paradise frequency threshold: ≥7 documented, clinically significant sore-throat/tonsillitis episodes in the past 1 year, or ≥5/year in each of the past 2 years, or ≥3/year in each of the past 3 years. This remains the standard pediatric threshold used to consider tonsillectomy for recurrent

How should I manage streptococcal pharyngitis in a child with penicillin allergy?

Confirm group A streptococcal (GAS) pharyngitis first, then treat with a non-penicillin regimen based on whether the allergy is immediate/anaphylactic or non-immediate. In a child with true immediate penicillin allergy, use a macrolide or clindamycin; in non-immediate, non-severe allergy, a first-generation cephalospor

Which first-line antibiotic and duration should I use for streptococcal pharyngitis in a child?

Use oral penicillin V or amoxicillin for 10 days as first-line treatment for confirmed group A streptococcal (GAS) pharyngitis in children. Amoxicillin is commonly preferred in pediatrics because of palatability and once-daily dosing options; penicillin remains the standard narrow-spectrum first choice. - Amoxicillin 5

When should a rapid antigen test be followed by throat culture in a child?

In a child with suspected group A streptococcal pharyngitis, a negative rapid antigen detection test should be followed by a throat culture if clinical suspicion is sufficient that you would treat if GAS were confirmed. A positive rapid antigen test usually does not need backup culture because specificity is high. This