This is the tail end of flu, cold and sore throat season. All my healthy adult patients are busy with business and social events and family visitors. None of us have time to be sick. At the first sign of a sore throat, runny nose and cough I am being asked to prescribe an antibiotic. In most cases adult sore throats are caused by viruses which do not respond to antibiotics. Not only are antibiotics ineffective but their side effects may make you as ill or worse than the illness you are attempting to treat. “I know my body and it always responds to a Z-Pack,” is a common phrase heard in local medical offices, walk in centers and emergency departments.
With this as a background it was interesting to see a publication in the Annals of Internal Medicine this month investigating the causes of a sore throat. Dr. Robert M. Centor, from the Department of Internal Medicine at the University of Alabama in Birmingham, performed throat swabs on 312 patients reporting a sore throat at a university health clinic and compared the results with the throat swabs of 180 healthy but similar students. Dr. Centor has developed a clinical algorithm and scale for determining when one should do a throat culture and when it is likely that the sore throat is due to Group A Streptococcus and requires antibiotics. Dr. Centor had the advantage of using polymerase chain reaction techniques to look for anaerobic mouth bacteria called fusobacterium necrophorum that normally resides in the mouth, can cause infection but is not detectable by routine and commercially available tests.
Dr. Centor found that 10% or less of adult sore throats are caused by bacteria specifically Strep throat. An accompanying editorial on the subject reminded physician readers that good old fashioned penicillin is still the drug of choice for a Strep throat with no resistance ever having been detected. They went on to say that an increasing percentage of Strep throats are resistant to a Z Pack so it should not be the drug of choice.
Dr. Centor in his scoring scale noted that if you didn’t have a cough, swollen or tender cervical lymph glands, a temperature > 100.4 and a tonsillar exudate, you probably didn’t need a throat swab for strep A. In adults, when a rapid Strep test was performed and it was negative there was little if any chance that a traditional throat culture would have a different result.
The message from this is that if you are an adult and have not been around young sick children then your sore throat is probably viral and does not need an antibiotic. If your temperature isn’t elevated and your glands aren’t swollen and your tonsils and throat don’t have a white coating then you probably do not have a bacterial strep sore throat either. Grab those lozenges, sucking candies, warm fluids and wait it out.
Dr. Reznick is board certified in internal medicine and has practiced in Boca Raton and the surrounding communities since 1979. For information about his concierge practice, call 561.368.0191 or visit http://www.BocaConciergeDoc.com.
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