Tuesday, November 12, 2013

Why don't pediatricians just treat everyone with a sore throat for Strep throat?

      We are asked on occasion why we pediatricians do not "just treat with antibiotics" everyone with a sore throat. I want to answer that question. I feel pretty strongly about it.
      1. Antibiotics only treat bacterial infections -- not viral infections.
Most sore throats are not caused by bacterial infections. Less than 1 in 7 of our rapid strep tests done in the office show strep. And 1 in 14 of our over-night strep tests (through Nationwide Children's Hospital ChildLab) are positive for strep. So for the vast majority of sore throats, antibiotics will not help. They will not help because the sore throats are caused by viral illnesses.
      2. The overuse of antibiotics is causing bacteria to evolve to become more resistant.
Many antibiotics are losing their strength against the usual bacteria we treat. As important it is to take an antibiotic when you need it, taking one if you do not need it is bad. This will kill healthy bacteria. Any bacteria that do survive through your course of antibiotics will now be resistant to the antibiotics. Many common infections (ear infections, sinus infections, pneumonia, skin infections, urinary tract infections) are caused by more resistant bacteria requiring stronger and stronger antibiotics. This is very worrisome.
      3. Although scientists are studying new antibiotics all the time, no new antibiotics for common infections are coming anytime soon.
New medications are being studied and tested all the time. New medications are available for many conditions. However, there are no new antibiotics "coming down the pipeline" that will help treat common bacterial infections. In fact, the antibiotics that are taken by mouth available for use in children have not changed since 1997. The commonly used antibiotics (amoxicillin, cefdinir/Omnicef, amoxicillin-clavulanate/Augmentin, azithromycin/Zithromax, and sulfamethoxazole-trimethoprim/Bactrim) are the same ones used for 16 years. Thank goodness they work for the common bacterial illnesses so far!
      4. The chances of "missing a Strep infection" and something bad happening is tiny.
Although there are brief sore throats that are not tested (for strep throat) that do turn out to be strep, it is very rare to have someone tested, miss a strep infection, and have an untreated strep throat complication -- such as rheumatic fever.

       We are all frustrated with sore throats. Especially when they are accompanied by headache, fever, and upset stomach, we hope someone with a sore throat has strep so that we can treat them with an antibiotic and they will quickly feel better, they will be not contagious quickly, and complications (such as rheumatic fever) will not occur. But if you do not have strep throat, taking an antibiotic will not help -- and can be dangerous.

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