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Diagnosed With Strep Throat. Given Tylenol. Done Blood Tests. Treatment?

Posted on Sat, 7 Sep 2013

Question: hello. my son was diagnosed with strep throat yesterday. We still had to go downto the clinic today and do blood test to rule out dengue (we live in latin america) His platelets are 335, it means no dengue. But, his wbc are 20.00, neutrophils are 80.7 and 16,2 u/l. and linfocites are 6.7 (normal 10-50). The rest is all normal including red blood cells. When will the WBC count go down? He has been trouble to swallow, stomachache and hig fevers all day, 103.5. Tylenol brings it down to 102.5 However, for the last two hours fever went down to 101.7. HE started antibiotics the morning at 8AM. My son will turn eleven in one month. I do not seem to get a hold of the pediatrician at this time of the night.

Answered by Dr. CS Narayan (35 minutes later)

Hello and thanks for your query.

I shall make an effort to provide you with good professional recommendations specific to your questions.

His WBC (Neutrophils) will go down after the infection is controlled by the prescribed antibiotic. The lymphocytes have also dropped due to the usage of the same to combat the infection and will rise once he starts feeling better over few days. As he has started antibiotics in morning, it will take 3-4 dose numbers in the given course to attain the required levels to gain control of the streptococcal bacteriae and thereby improving the symptoms of fever.

The difficulty in swallowing due to to the swollen lymph nodes in the throat region and the irritation itself due to infection will also improve with above. Meanwhile, give him lukewarm soups that he likes and not any cold/room temperature liquids. Solids may also need to avoided for now except soft and warm diet. The stomach ache may be due to the slight irritation of the antibiotic and will eventually subside.

Be ready to report to emergency dept even if pediatrician is unavailable, whilst you have a good eye on him through the night and if his fever is rising above 103/104 persistently inspite of required tylenol and antibiotic dose frequencies.

Let me know if I have missed out any other concern in your question.

Yet again, I duly appreciate your query to me, I do hope that you have found something useful to help you and I shall be glad to answer any further apprehensions.

Sincerely,

Dr Sujeet, MBBS, MD.
Consultant Physician.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. CS Narayan (26 minutes later)

Thank you so much for your response. My biggest concern right now is his fever. I am giving him 500 mg of tylenol (He weights 104 pounds) every four hour. It takes one hour for the fever to go down from 103,5 to 102.5. Then, before the four hours of tylenol, his fever starts going up again. It has reached up to 103.8 and then slowly goes down to 102.5. This las fever was the most encouraging one. Fever went down within the first hour and it reached down to 102. Are these normal temperatures for strep throat?

Answered by Dr. CS Narayan (16 minutes later)

Thanks for your followup.

Yes, temperatures like these do happen with Streptococcal sore throat in infants.
Do make sure you follow the package dosing guidelines.

104 Pounds ? I think you mean 10.4 pounds right ?
If so dose is 40 mg and NOT 500 mg ?

I have a link for you as a good guide.
WWW.WWWW.WW

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. CS Narayan (1 hour later)

My son is eleven years old and weights 104 pounds. Are high fevers this high in teens too? His temperature has gone down to 102 with tylenol.

Answered by Dr. CS Narayan (12 minutes later)

Thanks for the confirmation.

Yes, it is. High fever above 108 F is a big concern medically. Else he should do well.

Let me know of any further queries.

Sincerely,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. CS Narayan (47 hours later)

Hello dr. This is to follow up with my son's condition. He has been on antibiotics for two and a half days, 8 doses of antibiotics. His fever hasn't gone down from 103.5. When given Tylenol or ibuprofen it goes down to 100.8 for a few hours. He has a runny congested nose, and he complained of his left ear being clogged. Our oldest son also had pharyngitis strep throat and was just given a shot of penicillin by his allergist. Should we wait any more time? All the comments I receive is that my son should have started feeling better within 24 hours of starting antibiotics. He did started to eat on Saturday (48 hours after first dose of fosfomycin- 500mg).

Answered by Dr. CS Narayan (6 hours later)

Thanks for your followup.

Fosfomycin antibiotic that you have mentioned, is intriguing here.
I would not have prescribed that drug to my patients, especially for a streptococcal sore throat in a child less than 12 years. And moreover, this drug is given in a single dose and not to be repeated unless needed in some rare cases. And you have mentioned 5 doses of Fosfomycin each of 500 mg ?

You have not indicated if your pediatrician has prescribed which antibiotic ? And you are mentioning Fosfomycin retrospectively now, which is indicated for an entirely different condition altogether.

I would suggest you to get him examined to a pediatrician at the earliest.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar