"My throat is STILL sore..."

http://www.jabfm.org/content/22/6/663.full

No doubt, sore throat is a common issue in the express cares. What is the consensus though, when the throat culture returns only to show "Beta- hemolytic strep, not Group A or C?" Note that these letters refer to Lancefield groups of streoptococcal bacteria, and include Groups A,B,C,F and G, all of which are beta-hemolytic streptococci on blood agar mediums.

To shed some light on this issue, I linked the above 2009 article. Some interesting points from this as well as the UptoDate article following are:
http://www.uptodate.com/contents/group-c-and-group-g-streptococcal-infection?source=search_result&search=pharyngitis+treatment&selectedTitle=7%7E150

1. Groups C and G streptococcus have NOT been associated with formal cardiac rheumatic fever or post-streptococcal glomerulonephritis. However, these bacteria have been implicated in internal infections including actual (non immunologic) endocarditis, septic arthiritis, and UTIs,  and as such have some pathogenic risks in certain organs.

2. Groups C and G are almost uniformly susceptible to penicillin. However, there is common resistance to macolides. As such, this may be the cause of patient callbacks of "my throat is killing me" despite a negative rapid strep test and no response to Zithromax.

3. Per the UptoDate article, treating these infections with antibiotics can be accomplished in 5 days. As mentioned above, due to no associated immunologic induced rheumatic fever or glomerulonephritis, the standard 10 days of therapy for sore throat does not have to include these isolates. Of course, Group A strep throat infections do need the usual 10 days of penicillin.

4. The real "$64,000 dollar question" that both articles above and the literature in general seem to skirt is whether or not treatment with antibiotics of non-group A streptococcal throat infections leads to faster clinical improvement. The UptoDate article says treatment IS appropriate, but the actual efficacy is still debated.

5. In the first cited article there is a good review of the often used Centor criteria that can allow presumptive treatment despite a negative rapid strep. Please note that the more rigid Infectious Disease Society of America (IDSA) disagrees with most primary care physician groups (like the AAFP) on the validity of antibotic treament based solely on the Centor criteria. These criteria are fever (over 99.5F), palpable cervical lymph nodes, exudates in the pharynx, headache, and absence of cough. Sensitivity when all 5 of these are present approaches 80%.

6. One practical pearl, don't forget when confronted with pediatric fever, headache, and sore throat, with POSTERIOR cervical lymph nodes, be sure to consider mononucleosis in your differential. Plus, recall that aside from the typical mid-late adolescent, the NEXT most common group for mono is toddlers and early elementary school children (recall it is saliva transmitted-which includes not just kissing but sharing beverages/"juice boxes").

Comment below on whether or not anecdotally you see that antibiotics help or hasten recovery from non- Group A beta-hemolytic pharyngitis infections. What is your stance? I realize that again, the literature varies so you may base your practice on a different study or study reliability/methodology. The more views the better, so comment...when you are going through the pending labs and a throat culture comes back NON Group A beta hemolytic strep, do you call in antibiotics?