Dr Phil: How can I help my teen avoid another strep throat? 

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My teenage daughter gets a step throat almost every year, which requires an antibiotic. Is there an alternative treatment and how can I ensure she doesn’t pick up another infection?

Tonsillitis is awful. The sickest I have ever been was when I had tonsillitis, so I’ve immense sympathy for recurrent sufferers. 

Tonsillitis can be bacterial but it’s usually viral. Streptococcus is the most common bacteria that causes tonsillitis, which is why you often hear people talking about strep throat. In your daughter’s case, the first step I would take is to confirm if strep is responsible. There is a chance these are recurrent viral infections, which would mean the yearly antibiotic treatment is unhelpful. 

Chat with your GP about doing a swab next time she gets a throat infection and holding off on antibiotics until the result is back. Given that she is getting yearly strep infections, it may be worth looking at a longer course of antibiotics at a lower dose (usually once per day for a month). The idea here is to eliminate strep bacteria living in her throat. This “strep colonisation” is common and usually doesn’t cause any issues but, for a small minority, it can be the source of recurrent infection.

I would also ask if she smokes or vapes, as both will seriously increase the rate of throat infections and airway problems. Unfortunately, the downward trend in teenage nicotine use we have seen over the past number of years has stopped due to vaping becoming more and more popular in this age group.

If your daughter has asthma and it’s insufficiently controlled, it increases the risk of strep infections. A good marker for well-controlled asthma is not needing to use your blue inhaler more than twice per week (excluding sports). This means four blue inhalers should last you a year. If you use more than this, your preventer treatment isn’t enough.

If none of the above can be improved, then I would look at what you can do to help improve her immune function. The big topics here are sleep, exercise, and nutrition.

A number of recent studies have shown that teenagers’ natural sleep rhythm doesn’t match the school schedule. This leads to many in this age group getting less sleep than they need as they naturally feel like staying up later. Teenagers need about eight to 10 hours of sleep per night.

We should all be aiming to do some exercise that gets our heart rates up 30 minutes per day five days per week and this goes even more so for teenagers (even in exam years as exercise helps memory and concentration). And make sure she is eating enough veg and iron and staying hydrated as all of these are essential for normal immune function.

Overall, if she gets tonsillitis once per year I would not advise removing her tonsils, but hopefully there are a few things listed here that you can look into.

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