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Page 1 of 2 Throat pain accompanies colds, allergies, and strep infections. The tonsils may be swollen, red, and pitted with yellow pus. Lymph nodes below the jaw tend to get swollen as well. Fever and other cold symptoms may also accompany the sore throat. A high fever, as much as 104°, may signify strep throat, which is generally more severe than viral sore throats, takes longer to go away, and is occasionally accompanied by a rash. In other respects the symptoms can be similar and even indistinguishable unless a throat culture is obtained.
Antibiotics for strep?
Most pediatricians will insist on treating strep throats with antibiotics. The specific organism is Group A beta-hemolytic streptococcus. The effect of antibiotics on the recovery from strep throats has been controversial, with early studies showing no effect on symptoms (Brink, 1951; Denny, 1953) and later studies showing dramatic improvement (Randolph, 1985). The second reason doctors treat strep with antibiotics is because they can prevent one of the complications of strep throats, namely acute rheumatic fever (ARF), which commonly damages heart valves and can prove fatal. Antibiotics do not seem to prevent some other complications, specifically toxic shock syndrome or kidney infections (Weinstein, 1971). However, the incidence of rheumatic fever has decreased dramatically since the age when thousands of people died every year from rheumatic fever. In the late 1940s, 200,000 people per year developed rheumatic fever. That incidence began declining prior to the availability of antibiotics and ARF has nearly disappeared since the 1970s. Pockets of ARF occur sporadically in various small areas of the country, but by and large rheumatic fever is now a disease of the past. Apparently, the strains of the bacteria that have an affinity for attacking the heart simply do not occur anymore except in rare isolated instances (Markowitz, 1998; Stollerman, 1990). Once upon a time antibiotics prevented ARF that followed strep throats, but now the disease has virtually disappeared despite the fact that most sore throats do not get treated. In fact most cases of ARF now have no history of a preceding sore throat.
None of this would be an issue if antibiotics had no side effects. The problem is that they do. Antibiotics disrupt the immune system, and kill beneficial bacteria along with the pathogens. Antibiotics also tend to create resistant strains of bacteria so that they do not work effectively when they are really needed. A further complicating issue is that strep bacteria typically do not disappear from the throat following a course of antibiotics. The bacteria will persist even after signs of the infection have disappeared. If a throat culture is taken at some later date, the bacteria will still be present and another antibiotic prescription will follow even though there is no active infection. Finally, studies have shown that when antibiotics are given for strep throat the infection tends to recur more often than when they are not prescribed.
I do not recommend antibiotics for strep throat unless there are an unusual number of documented RF cases caused by strep bacteria in the community, or if the patient has pre-existing heart disease. I agree with pediatrician Robert Mendelsohn who wrote as long ago as 1984:
Both throat cultures and antibiotics are to be avoided, because the hazards of treatment outweigh the remote possibility that your child will suffer any lasting effects even if he has a strep infection (Mendelsohn, 1984).
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