If a patient has a Strep score of 2 to 3, what is the next step?

When a patient has a Strep score of 2 to 3, it indicates a moderate likelihood of streptococcal pharyngitis based on clinical criteria like a history of fever, absence of cough, and swollen lymph nodes. In this scenario, the next appropriate step is to perform a rapid antigen test. This test will help confirm the diagnosis of streptococcal infection by detecting the presence of Group A streptococcus in the throat swab, allowing for a swift and accurate determination of whether antibiotics are warranted.

If the rapid antigen test is positive, it would justify the initiation of antibiotics, as this would indicate a confirmed streptococcal infection. Conversely, if the test is negative, further evaluation may be needed, but the results allow the clinician to make informed decisions regarding treatment and management plans.

This approach is particularly important because it helps to avoid unnecessary antibiotic use and manages patient care effectively based on evidence. Other options, such as starting antibiotics immediately or providing only symptomatic treatment, do not address the necessity of confirming an infection before treatment initiation. Referring a patient to an ENT specialist at this stage would also be premature without first performing the diagnostic test.