Strep Overtreatment

My kids used to get strep throat a lot. And my first instinct when more then one of them came down with it was to get the entire family on antibiotics as quickly as possible. My old family doctor went along with me a lot of the time, too. He was very concerned about our family's health, and wanted everyone to feel good. After a couple of times of strep outbreaks in our family, where we would get everyone cultured and treated, he started prescribing antibiotics for any other member of my family who I told him had symptoms if we had one child test positive.

With our change of medical insurance last August, we started going to a new clinic. We now see Dr. Johanson. He has proven himself to be caring about our family, too, but in a different way. Benjamin was complaining about not feeling well a lot last year. He didn't have any severe symptoms, and Aaron and I were pretty sure he had a case of hypochondria. Ben had a checkup with Dr. Johanson, and he was in good health. A few weeks later, there was strep going around, and Ben started complaining about every symptom in the book again. I had another child at Dr. Johanson's office for a physical, and I asked him whether I should bring Ben in for a strep culture. He asked a few questions, which are very important.

1) Does his throat look red and swollen?

2) Does he have a fever?

3) Does he have any other symptoms, such as a raging headache, or something else debilitating?

The answer to all of these was no.

Dr. Johanson then explained something to me. First, overtreatment with antibiotics is causing resistance in organisms that are more potentially dangerous than strep. Second, the body is perfectly capable of fighting off strep infections in most cases. The risk of not treating it is that a case of rheumatic fever can occur a few weeks later, which has a potential for damaging a heart valve. However, new studies show that rheumatic fever only occurs in 3% of untreated cases of strep, and only after a strep infection that comes with a high fever (over 102 degrees F) for several days. Therefore, the only time he wants me to bring my kids in for a strep culture is when they have a fever with a sore throat, or if they have other severe symptoms that I would keep them home from school for, such as a very red sore throat and headache, and I think they have been exposed to strep.

I was a little surprised. I had thought that strep was something that we just shouldn't allow to exist. I didn't take his word for it alone. I decided to look it up online. Guess what? What he said is considered best practice in medicine by all of the reliable sources I could find online.

I found out something else when I researched this that I found fascinating, and which explains why some of my healthy children would come up with positive strep cultures every time they were tested.

First, many people are healthy carriers of strep bacteria (meaning they don't have any symptoms of illness), and the likelihood of them spreading strep if they have no symptoms is considered minute. In fact, a strep carrier will probably have a positive strep culture every time they are cultured, even when they are feeling completely healthy. No amount of treatment will make it so that they quit being a strep carrier, as when they are exposed to strep again, they will probably not get sick, and will again be a healthy carrier. So, unless they get symptoms that are related to strep (sore throat, fever, headache) and not viruses (such as a sore throat with a runny nose, sneezing, or cough), they should not bother going in for a strep culture.

I also found out more about the connection with rheumatic fever. The shortest time that it can onset after a case of strep with a fever occurs is 9 days. Best practice in medicine is that there is no reason for a doctor to treat an unconfirmed case of strep where there are not overwhelming signs of strep until a positive strep culture is confirmed, or if there are special circumstances which call for immediate treatment.

I asked my doctor what to do with a child with a mild sore throat who has been exposed to strep. Do I keep him home from school? His answer was no. If they aren't sick with a major symptoms, the likelihood of spreading it is minimal. And, if they have a throat culture that hasn't grown out positive yet, the bacteria isn't developed enough to be getting others sick. I even wonder about treating a healthy child whose 48-hour culture turns out to be positive, if he no longer has signs of strep. It seems to me if they aren't being affected by symptoms, they probably beat it themselves.

I'm glad I found all of this out. I will be spending a lot less on doctor's office copays and prescriptions in the future, and my kids won't be staying home from school quite as often.