From HealthDay, new guidelines for avoiding bacterial resistance when treating strep throat:

Doctors need to accurately diagnose and treat strep throat in order to avoid inappropriate use of antibiotics that can lead to drug-resistant bacteria, according to updated guidelines from the Infectious Diseases Society of America.

Pediatricians have long known that the gold standard for diagnosing strep throat is the throat culture.  And we do a lot of throat cultures in our offices!  It’s important to us, to your child, and to the community to know which sore throats are caused by streptococcal bacteria and which are not.

Most sore throats are caused by a virus, however, not by Streptococcus bacteria, and should not be treated with antibiotics, which are ineffective against viruses…

Strep throat symptoms usually have a rapid onset.  The primary symptom is a sore throat.  There is often a fever.  Some kids complain of a headache, some may have swollen  glands or lymph nodes in the neck,  and some kids will vomit.  Some may even develop a rash.  But the main complaint is a sore throat.  It hurts to swallow, and, generally, kids don’t feel very well.

If a child has a sore throat, but also has significant symptoms of a cold, like a runny nose and cough, then the cause is probably a virus, not strep.  Most of these kids don’t even need to be seen in the office or take antibiotics.

Research shows that up to 15 million people in the United States go to the doctor for a sore throat every year. As many as 70 percent of patients receive antibiotics for a sore throat, but only 20 percent of those patients have strep throat, according to the IDSA.

This is also well-known by most pediatricians, who generally refuse to treat viral illness with antibiotics.  Most parents understand this as well.  Yet there are still plenty of doctors and other providers who are not pediatricians but who still care for kids at local urgicare centers (which seem to be everywhere) who still don’t get it.

It is astounding to me how many parents tell me they are on antibiotics for a strep throat.  When I ask them whether their doctor did a throat culture, most say no.  So I ask:  “then how did they know?”   “They just looked in my throat, said I had strep, and wrote me a prescription.”  Wow.  And it’s usually a very strong and expensive antibiotic.  “Like killing a mosquito with a hand grenade,” I say.

As pediatricians, it is our duty to try our best to differentiate between bacterial and viral infections in children.  Sometimes there will be a culture, or an X-Ray, or a blood test involved.  Sometimes we can diagnose it in the office, and sometimes we’ll need to send your child to an emergency room to gather more information.

And as important as it is to make a proper diagnosis and provide appropriate treatment, it is also a pediatrician’s obligation to explain to children and parents what it is we are doing, and why we are doing it.

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