5 ms·

Erm. Strep throat is pretty severe, and also actually a bacterial infection. That's not a great example of antibiotic overuse. Better example is doctors writin

Erm. Strep throat is pretty severe, and also actually a bacterial infection. That's not a great example of antibiotic overuse. Better example is doctors writing prescriptions for common cold infections that are viral anyway so they can appease patients by "doing something."

thomyorkie 10y ago
I think his point was that the boy's mom wasn't careful to ensure all the bacteria had actually been killed. The boy probably kept getting strep because some bacteria had survived and thus the bacteria could have become resistant to the antibiotic.
hanklazard 10y ago
Primary care doc here. I agree that strep is "severe" as in "makes you uncomfortable with a fever, sore throat, enlarged tonsils, etc" but the infection generally resolves without antibiotics, if given proper time. The main rationale for treating strep pharyngitis (aside from appeasing patients) is prevention of rheumatic fever, a rare but devastating heart condition that occurs as a sequelae of untreated strep throat. Given the rareness of RF in the developed world, there are those in the infectious disease and primary care communities who think it is an excellent example of antibiotic overuse.
- danjayh 10y ago
  I had untreated strep when I was a kid, because the strep screen came back negative. Turns out it was group C, which didn't show up on the strep screen, but also didn't resolve itself. Some months later it got much worse. Somebody finally did a culture, figured it out, and gave me antibiotics (which cleared it up). Fast forward to age 29, when I had to have open heart surgery to get a mechanical mitral valve, for which I have to be on warfarin for the rest of my life (which comes packaged with increased risk of stroke and hemorrhage for the rest of my life) along with a beta blocker ('bystolic', aka nebivolol) because something happened to mess up my heart rate regulation during the surgery. I'd call strep pretty serious.
  - hanklazard 10y ago
    I'm very sorry to hear about your medical situation. I agree that RF and RHD are very serious ... my comment was only to say that treatment of a (frequently) self-resolving condition with 10 days of strong antibiotics has been an ongoing topic of debate due to the likely contribution to antibiotic resistance among other concerns. Here's a representative editorial from a few years ago: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949249/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949249/ Your condition is the reason that I find myself prescribing courses of amox even when chances of chronic strep colonization are much more likely than true acute infection. It's a real diagnostic quandary.
garrettgrimsley 10y ago
The key words there are appeared better, meaning that the mother halted the treatment once the child was no longer symptomatic. Assuming that the author of the parent comment is from the US or EU then the amoxicillin would have been prescribed. If the course of treatment was carried out then there would not have been any amoxicillin left over.

thomyorkie 10y ago

I think his point was that the boy's mom wasn't careful to ensure all the bacteria had actually been killed. The boy probably kept getting strep because some bacteria had survived and thus the bacteria could have become resistant to the antibiotic.

hanklazard 10y ago

Primary care doc here. I agree that strep is "severe" as in "makes you uncomfortable with a fever, sore throat, enlarged tonsils, etc" but the infection generally resolves without antibiotics, if given proper time. The main rationale for treating strep pharyngitis (aside from appeasing patients) is prevention of rheumatic fever, a rare but devastating heart condition that occurs as a sequelae of untreated strep throat. Given the rareness of RF in the developed world, there are those in the infectious disease and primary care communities who think it is an excellent example of antibiotic overuse.

danjayh 10y ago
I had untreated strep when I was a kid, because the strep screen came back negative. Turns out it was group C, which didn't show up on the strep screen, but also didn't resolve itself. Some months later it got much worse. Somebody finally did a culture, figured it out, and gave me antibiotics (which cleared it up). Fast forward to age 29, when I had to have open heart surgery to get a mechanical mitral valve, for which I have to be on warfarin for the rest of my life (which comes packaged with increased risk of stroke and hemorrhage for the rest of my life) along with a beta blocker ('bystolic', aka nebivolol) because something happened to mess up my heart rate regulation during the surgery. I'd call strep pretty serious.
- hanklazard 10y ago
  I'm very sorry to hear about your medical situation. I agree that RF and RHD are very serious ... my comment was only to say that treatment of a (frequently) self-resolving condition with 10 days of strong antibiotics has been an ongoing topic of debate due to the likely contribution to antibiotic resistance among other concerns. Here's a representative editorial from a few years ago: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949249/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949249/ Your condition is the reason that I find myself prescribing courses of amox even when chances of chronic strep colonization are much more likely than true acute infection. It's a real diagnostic quandary.

garrettgrimsley 10y ago

The key words there are appeared better, meaning that the mother halted the treatment once the child was no longer symptomatic. Assuming that the author of the parent comment is from the US or EU then the amoxicillin would have been prescribed. If the course of treatment was carried out then there would not have been any amoxicillin left over.