In a child with persistent fever and sore throat after negative rapid antigen tests for GABHS, what is the most appropriate next step?

In a child with persistent fever and sore throat after negative rapid antigen tests for GABHS, what is the most appropriate next step?

• A. Repeat rapid strep testing
• B. Obtain a throat culture
• C. Order a monospot test
• D. Reassure viral infection and provide supportive care

Answer: (B)

In children, rapid strep tests are highly specific but not perfectly sensitive, so a negative result does not rule out streptococcal pharyngitis when fever and sore throat persist. The best next step is to obtain a throat culture because it has higher sensitivity and is the standard diagnostic method to confirm GABHS in kids. If the culture grows GABHS, treat with appropriate antibiotics; if it remains negative, consider other causes such as viral infection or mononucleosis. A Monospot test is reserved for when mono is suspected based on clinical clues (like prolonged fatigue, posterior cervical adenopathy, or splenomegaly). Reassurance and supportive care would be appropriate only after a culture convincingly rules out GABHS.

In children, rapid strep tests are highly specific but not perfectly sensitive, so a negative result does not rule out streptococcal pharyngitis when fever and sore throat persist. The best next step is to obtain a throat culture because it has higher sensitivity and is the standard diagnostic method to confirm GABHS in kids. If the culture grows GABHS, treat with appropriate antibiotics; if it remains negative, consider other causes such as viral infection or mononucleosis. A Monospot test is reserved for when mono is suspected based on clinical clues (like prolonged fatigue, posterior cervical adenopathy, or splenomegaly). Reassurance and supportive care would be appropriate only after a culture convincingly rules out GABHS.