Sore Throat

Patients often present to our office, or the Emergency Department with a "Strep Throat" and ask for antibiotics to treat their infection.

It is very important to define what we are talking about. Strep throat is a bacterial infection (proven with a throat swab). The more appropriate term

is Pharyngitis, which encompasses both viral and bacterial causes of a sore throat.

You may have noticed that physicians no longer routinely prescribe antibiotics for a "sore throat", let's look at why:

Rationale

The vast majority of sore throats are caused by a virus and not bacteria. This is very important, as antibiotics do nothing to treat a viral illness.

Every time I get antibiotics it makes me feel better - this statement is very misleading, our bodies will fight off viral illness on their own, and the antibiotics did nothing to help. Even in cases of Strep, the antibiotics do not statistically shorten duration of symptoms.

What if the throat swab comes back positive for bacteria?

Interestingly enough, antibiotics only reduce symptoms by 12-16 hours in STREP Throat. Remember, the average sore throat lasts for 7 days, so reducing symptoms to 6.5 days hardly makes much of a difference. Antibiotics also do nothing to prevent the most common complications of Strep Throat - peritonsilar abscess, otitis media, sinusitis, and post strep glomerulonephritis.

So why do we treat Strep with antibiotics - This comes down to a very rare complication - Rheumatic Fever and Rheumatic Heart disease. This complication became so rare, that the CDC stopped tracking its rates in 1995 (rates fell below 1 in 1,000,000). The current standard of practice is to treat all proven cases of Strep Throat with antibiotics, however this may change in the future

What are the HARMS of giving everyone antibiotics?

Vomiting, diarrhea, upset stomach, rash, severe allergic reaction, and increasing antibiotic resistance

Bottom Line

The vast majority of sore throats can be managed at home. Regardless of cause (bacteria or virus) symptoms of sore throat last on average 7-10 days. You can help relieve symptoms with acetaminophen, NSAIDs, salt water gargles and lozenges. It is important stay hydrated and get a good rest.

When to see a Doctor

Severe or persistent fever.
If you have trouble breathing or wheezing – especially if you are a smoker, have chronic bronchitis, emphysema, COPD, asthma, or other lung problems.
If you just have a very sore throat and fever, but no stuffy nose and no cough (this is more likely Strep Throat)
If your sore throat is much worse on one side, you notice unilateral swelling, or if you have trouble opening your jaw, or turning your neck.
If you are very unwell, or have any other concerning symptoms