Strep throat is a bacterial infection of the throat and tonsils caused by Streptococcus pyogenes. This infection requires antibiotic treatment. Taking antibiotics speeds recovery and, more importantly, prevents rare but serious complications, such as rheumatic fever, which can affect the heart. Many people worry when symptoms do not immediately disappear after starting medication or if they feel slightly worse initially. Understanding the typical recovery process helps manage expectations and identify when symptoms truly signal a problem.
Expected Recovery Timeline After Starting Antibiotics
Clinical improvement usually begins within the first 24 to 48 hours of starting antibiotics. Within a day, many patients notice that the fever begins to subside, which is often the first sign the medication is working. The severe pain and inflammation in the throat should also start to lessen significantly during this two-day window.
Patients are no longer considered contagious after 24 hours on the medication and once their fever has resolved. However, the entire 10-day course of antibiotics must be completed, even if all symptoms have vanished. Stopping treatment early allows remaining bacteria to survive, potentially leading to a relapse of the infection or increasing the risk of later complications.
Common Reasons Symptoms Might Persist
A feeling of worsening symptoms shortly after beginning treatment does not always indicate antibiotic failure. The body’s inflammatory response can continue to progress for up to 24 hours while the medication builds concentration in the bloodstream. Swelling of the tonsils, for example, may briefly peak before the antibiotics begin to reverse the inflammation.
Feeling unwell can also be linked to common side effects of the medication itself. Antibiotics frequently cause transient gastrointestinal discomfort, such as nausea, diarrhea, or mild stomach upset, which can be mistakenly attributed to a worsening infection. Some people also experience a temporary change in taste or a loss of appetite while taking the medication.
Sometimes, the initial sore throat is not solely caused by strep bacteria. A patient might be a silent carrier of Streptococcus pyogenes while simultaneously fighting a separate viral infection, such as a cold or mononucleosis. The antibiotic eliminates the strep bacteria, but symptoms related to the viral infection, like coughing or persistent fatigue, will continue until the virus runs its course. Missing doses can also lower the drug’s effectiveness, resulting in delayed symptom resolution.
Signs That Require Immediate Medical Attention
While minor discomfort is common, certain symptoms require immediate medical re-evaluation, particularly if they persist or worsen beyond the initial 48 hours of antibiotic use. A persistent or rising fever after two full days of treatment is a sign of potential treatment failure or a developing complication. This lack of improvement suggests the current antibiotic may not be effectively clearing the infection.
Specific localized symptoms can point to a peritonsillar abscess, which is a collection of pus that forms near the tonsil. Red flags for this condition include severe, significantly one-sided throat pain and difficulty opening the mouth fully, a condition known as trismus. A patient may also develop a muffled or “hot potato” voice and find it nearly impossible to swallow their own saliva, leading to drooling.
Other serious signs that warrant urgent care include any indication of a severe allergic reaction to the prescribed antibiotic, such as hives, a widespread rash, or swelling of the face, lips, or tongue. Difficulty breathing or experiencing severe neck stiffness should also prompt an immediate visit to an emergency department. These signs suggest the infection may be spreading into deeper tissues of the neck or causing airway compromise, requiring prompt intervention.