I read a fascinating article from Emergency Physicians Weekly (a free circular that ER docs get) which describes how treating strep throat with antibiotics became the norm. And thus, leading to bigillions of viral infections (misdiagnosed as strep)being unnecessarily treated as well. Who can we blame? Some researchers in the 1940′ at a military base in Wyoming. This is a must-read.
The point of the article is that the data that was used to make the recommendations was from a small pool of patients during an unprecedented outbreak of rheumatic fever. Rheumatic fever (thought to come from strep infections) can cause severe heart disease later in life. It is now very rare at baseline, so to prevent one case of it, one has to treat hundreds of thousands of strep throats. Every study done since then has only shown minimal improvement with Abx treatment – 16 hour shorter duration. No case of Rheumatic fever has ever been reported in a trial of comparing antibiotics to placebo in the treatment of strep throat in 50 years!!!!! Now think of all the possible (and frequent) dangers of Abx – resistance, c. diff colitis, diarrhea, vomiting, allergic reactions, etc.
What are we treating? Patients’ expectations is what we are treating. They expect antibiotics because they have grown up expecting them – from millions of unnecessary treatments over the years by doctors going on outdated treatment concepts.
There should be a campaign like M.A.D. D.(Mothers Against Drunk Drivers) for this – I would call it “D. A. A. F. T.” or Doctors Against Antibiotics For Tonsillitis.
I love reading your blog..very interesting and comical. I was on your site yesterday while at work. a boston hospital when i was hijacked to porn. i could not X out of the pages fast enough. i finally shut down the system and called the IT dept. I did not want that info on my sign in log. (i was reading the peroxide post and did not click on anything, but did bring the mouse over a high lighted area). Lesson learned, I should not read blogs at work
Yeah, the previous post had some toxic code on it. I removed all the ad code from the individual posts but now the spacing is all screwed up. I am attempting to fix it now. The redirects from comments sections of single posts should stop now.
Very interesting. I got tonsillitis as a kid, so was always on antibiotics. I can still hear the Dr. telling my mom the risk of rheumatic fever if we didn’t treat the strep with antibiotics. I finally got my tonsills removed and no more swollen throats and fevers.
I dont understand??? Twice my doctors have withheld antibiotics for step throat and twice it has started to spread to my Lymph Nodes (one time it succeeded and I was the only person in the hospital for strep throat). Maybe it is just my body’s inablility to fight infection because I also have developed pnumonia two times (i have asthma) after getting a cold/flu and once without being sick before hand. I dont like antibiotics because I get killer yeast infections every time I take them, but my doctors are very afraid I will end up in the hospital again.
I really Enjoy your Blog and it is very informative.
Lena,
Your lymph nodes can get swollen and tender with or without antibiotics. That is a normal reaction to any infection viral or bacterial. Not treating or treating a viral pharyngitis even with swollen tender lymph nodes dose not change the course of the infection. If antibiotics are given, the lymph nodes will swell and be tender and gradually go away.
Very interesting – I’m not in the medical field, just enjoy reading your blog – I had my 6 year old daughter in to her pediatrician last week for a sore throat. Per the culture, it was not strep, so no abx (yay – I’m a firm believer in saving those drugs for real, honest-to-goodness infections that require them!) and she commended me for bringing my daughter in to get the culture, because “strep can easily turn into rhemuatic fever leading to heart disease, etc.” She made it sound like this was the norm if antibiotics were not given for strep!
Exactly Chris, this whole idea that “Strep can easily turn into rheumatic fever” is completely not validated by ANY studies. I would not consider 1 in 50 (as was stated during the 1944 trial) “easily” and now we know that number is much, much less in this day and age. This medical teaching we got is very out of date.
[...] ER Stories also has some discussion on the topic. Embarassed to say that TK scooped me on an article on my own site. [...]
My grandma NEVER had either of her children on antibiotics. Apparently her doctor told her to use common sense and quit bringing in the kids for the sniffles. It worked. My grandma is 86 and has only been to the doctor one time for herself other than bringing babies into the world. My Mom brought us to the MD “kaiser brat kids” but I can only remember being on antibiotics once for an ear infection. We were treated at home for cold with steam, tea, hot totties at grandma’s (that was her old fashioned common sense) not a popular one in today’s culture. I am not anti-biotics but agree that they are way over used. Sometimes a cold just lasts for 10 days or longer it sucks but no antibiotics aren’t gonna help. I wonder what all the antibiotics given pre-op and post-op routine for 24 hours are going to do? The monster bugs are going to have babies.
Unlike with strep, there is recent evidence to support antibiotic use pre-op, Toni.
I have seen and still see both sides of the antibiotic misuse story. I am in medical school and have been taught 1 out of every 3 GABHS tonsillitis infections untreated with antibiotics turns to scarlet fever, and 1 out of every 3 cases of scarlet fever still left untreated turn to PSGN or rheumatic fever or both. On one hand, over-using atbs has many negative outcomes, but on the other hand under-using them can also lead to these scary outcomes (although maybe less than taught to us). My infectious disease professor said it should be dealt with case by case, swabs, ASO levels,etc should be taken, but a good history (for recurrent infections, etc should also be taken into acct). Also, dont forget that some ppl with viral infections that dont get the rest and fluids needed, end up with bacterial superinctions and the blame will be laid upon the primary doctor for not treating this with prophylactic atbs.