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New guidelines underscore why most sore throats should not be treated with antibiotics

Very few sore throats — only 5 to 15 percent of those in adults and 20 to 30 percent of those in children — are caused by streptococcus bacteria.

Antibiotics are great at clearing up strep throat, but very few sore throats are actually strep.

I’m always surprised by how quickly people with a sore throat — even a severe one — jump to the conclusion that they have strep throat.

That means they also jump to the conclusion that their doctor must give them antibiotics as a treatment.

Antibiotics are, of course, very effective for treating strep throat. Not only do antibiotics quickly relieve the pain and other symptoms of the infection (usually within 24 hours), they also greatly reduce the chances of complications, most notably rheumatic fever and inflammation of the kidney. The drugs also shorten the time that people with the infection are contagious.

Yet very few sore throats — only 5 to 15 percent of those in adults and 20 to 30 percent of those in children — are caused by streptococcus bacteria. Most cases of pharyngitis (as sore throats are called in medical lingo) can be traced to viruses, not bacteria.

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And antibiotics have absolutely no effect on viruses. Our overuse of antibiotics is, however, contributing to an extremely serious (and growing) health problem: antibiotic-resistant infections. It’s estimated that such infections kill nearly 100,000 patients in U.S. hospitals each year. They’ve begun to affect healthy people as well.

The guidelines

Earlier this week, the Infectious Diseases Society of America (IDSA), released its revised guidelines for treating strep throat. The guidelines recommend against testing for strep throat when a patient’s symptoms strongly suggest a viral infection — in other words, when the sore throat is accompanied by a cough, a runny nose, hoarseness and diarrhea.

Testing in those cases is not necessary, say the guidelines, because those cold- and flu-like symptoms tend to be absent with strep throat. The distinctive features of strep throat is pain that comes on suddenly (as opposed to the gradual throat pain that characterizes a cold or flu) and a high fever. Other symptoms include headache, stomachache and vomiting (especially in children).

In addition to suggesting a more judicious testing process for strep throat, the IDSA guidelines offer these treatment recommendations:

  • Antibiotics should not be prescribed until a patient’s strep infection is confirmed with a throat swab culture test. Diagnosing strep throat from symptoms alone, the authors of the IDSA guidelines stress, is “usually impossible.” Yet all too often, doctors hand out antibiotics to patients without giving them the test — or waiting for its results. According to the IDSA, some 70 percent of patients who seek medical care for a sore throat are given antibiotics by their physicians. Yet, only 20 percent of those patients actually have strep throat.
  • Patients with strep throat should be treated with penicillin or amoxicillin (which must be taken for 10 days) and not with tetracycline, which has a strong link to anti-resistant infections. The IDSA also does not recommend cephalosporin and other short-term antibiotics for strep throat, citing their higher cost and a lack of good research about their effectiveness. (This recommendation is obviously not for people who are allergic to penicillin or amoxicillin.)
  • To help relieve the pain and fever associated with strep throat, adult patients can take aspirin, acetaminophen or ibuprofen. Aspirin should not be given to children or teenagers, however, because of its link to Reye’s syndrome. The IDSA also recommends against using corticosteroids for treating strep throat. The potential harmful effects of these drugs — which can include stomach irritation, a rapid heartbeat, nausea and insomnia — outweigh any benefits, they said.
  • Children who experience repeated strep throat infections should not have their tonsils removed if the sole purpose of the surgery is to reduce the number of infections.

The IDSA guidelines also clear up a common misperception about pets (especially dogs) and strep throat. “There is no credible evidence,” write the guidelines’ authors, “that family pets are reservoirs for [strep throat] or that they contribute” to the spread of the infection among family members.

The new guidelines were published in the IDSA’s official journal, Clinical Infectious Diseases, and can be read in full online.