(summary of an online lecture on Pharyngitis, by Dr. Robert Dachs MD)
One of my favorite examples of how the US Healthcare system + the US general public is addicted to antibiotics…
- 40 million doctor visits for “Sore Throat” every year in US, and 25% (10 million) of those visits end in a diagnosis of pharyngitis.
- Among adults, 70% of pharyngitis diagnoses get treated with antibiotics…
- BUT: in adults with pharyngitis, only 10% are actually caused by Group A beta-hemolytic Strep (GABHS).
Antibiotics overkill? Absolutely! But why are we Americans so freaked out about getting antibiotics for strep throat? Read on for common medical reasons for treating strep throat with antibiotics — and statistical evidence that most of these reasons are pretty unreasonable…
- Prevention of Acute Rheumatic Fever(ARF) (which can be caused by GABHS): ARF is extremely rare in the US (less than 200 cases in 2002) - you would need to treat 1,000,000 adult GABHS+ patients with antibiotics to prevent 1 death from ARF.
- Prevention of peritonsillar abscesses: most peritonsillar abscesses are caused by a mixture of viruses and bacteria and NOT by GABHS; a study in the UK showed that a 50% decrease in national use of antibiotics for pharyngitis over a 10 year period caused no increases in peritonsillar abscesses (or ARF)!
- Shorter course of sore-throat symptoms: if untreated, strep throat resolves in ~6 days; if treated with antibiotics, it resolves in ~5 days.
- Less contagiousness: no good data to prove this.
- Prevention of Post-Strep Glomerulonephritis (PSGN): treating strep pharyngitis does not prevent the formation of the antigen-antibody complex which actually causes PSGN; most cases of PSGN are caused by strains of strep which are different from the strains that cause pharyngitis.
Just some things to consider the next time you find yourself making a decision about using antibiotics for a sore throat or strep throat!
(Oh, and best treatments for strep symptoms: saltwater gargles, NSAIDs and acetaminophen, throat lozenges with benzocaine, and a single dose of oral steroids [found beneficial for both kids and adults in multiple trials!])