Getting the diagnosis right can help you avoid unnecessary antibiotics.
When your throat is raw and irritated, it can be hard to tell whether you’ve caught a minor viral infection, like a cold, or a more serious bacterial infection like strep throat. And you might be tempted to ask your doctor for treatment before you know the cause. About 70 percent of the 15 million people who see their doctor for a sore throat each year walk away with an antibiotic prescription, yet only a small fraction of them actually have strep.
Taking an antibiotic for a viral disease like a cold or the flu isn’t a good idea, because it contributes to the growing problem of antibiotic-resistant bacteria, or “superbugs.” “Also, people need to understand that by taking antibiotics for viral infections, they’re putting something in their bodies that they don’t need,” said Jeffrey A. Linder, MD, MPH, associate professor of medicine at Harvard Medical School, and associate physician at Brigham & Women’s Hospital, Boston. “Taking antibiotics unnecessarily exposes people to adverse drug reactions, allergies, yeast infections and nausea, with no benefit.”
Is it strep?
The most accurate way to know whether you have strep is to get tested for it. But don’t run to your doctor’s office right away. First, use your other symptoms as a guide. If you also have a cough, runny nose, and hoarse voice, you most likely have a virus and testing isn’t worth the trip, according to guidelines from the Infectious Diseases Society of America.
A fever, trouble swallowing, drooling, swollen glands in the neck, and enlarged tonsils do warrant a visit to your doctor or to your child’s pediatrician. These are hallmark symptoms of strep throat.
To diagnose strep, your doctor will take a throat swab. A rapid antigen detection test can pick up the presence of strep bacteria in just minutes. Yet this quick test doesn’t catch all cases of strep. When the result is negative, doctors will sometimes do a backup throat culture — especially in children — to confirm the results. Results take one or two days, but the culture can more accurately distinguish bacterial from viral infections.
Strep throat needs to be treated. Otherwise, the infection can spread to other parts of the body and lead to complications such as rheumatic fever (which can damage the heart and nervous system), kidney inflammation, and scarlet fever. Researchers are also investigating whether strep might trigger or worsen psychiatric conditions such as obsessive-compulsive disorder or tic disorder in children. This rare syndrome is called Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.
To clear up the strep infection and prevent complications, doctors typically prescribe antibiotics. “We recommend penicillin or amoxicillin for treating strep because they are very effective and safe in those who are not allergic, and there is increasing resistance of strep to the broader-spectrum — and more expensive — macrolides, including azithromycin,” said Stanford T. Shulman, MD, chief of the division of infectious diseases at Ann & Robert H. Lurie Children’s Hospital of Chicago and professor of pediatrics at Northwestern University Fineberg School of Medicine. If you or your child takes antibiotics, make sure to finish the entire course of medicine to ensure all the bacteria have been wiped out.
In the past, doctors recommended tonsil removal surgery for kids who had multiple strep infections. Today, tonsillectomy is reserved for children with more serious problems from strep, such as obstructed breathing.
Treating a virus
Most viral sore throats aren’t cause for concern. They’ll go away in a week or two without treatment. To soothe discomfort in the meantime, gargle with warm salt water, drink tea with honey, or take an over-the-counter pain reliever such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). (Don’t give aspirin or aspirin-containing products to children.)
Whether you have a cold or strep, follow the same advice. Stay home and rest until you feel better. You’ll get back on your feet more quickly, and avoid passing your germs to anyone else.
November 19, 2015
Janet O’Dell, RN