Myths & Facts: Sore Throat

This is one of my favorite topics. If you are an antibiotic-lover, you might be a little shocked to read what I have to write. However, I will try and give you unbiased information so that you can decide for yourself.  Let me just start by saying this… the way many doctors (especially pediatricians) approach sore throat, and more specifically strep throat, is one of the the most irrational practices in medicine. Billions of dollars are probably wasted on this irrational practice each year. The final irony is that in many cases your child may actually be worse off by seeing your doctor when they have a sore throat.  Of course that’s my opinion, so read on, and You Decide.

Myths & Facts

Myth #1: Most sore throats are caused by Strep

This statement is FALSE.  The vast majority of sore throats are caused by viruses.  By far the most common type of virus that causes a sore throat is the common cold.  The cold virus will cause your child to have a runny nose.  Some of that drainage will drain down the back of the throat (this is called post-nasal drip).  This drainage is very irritating to the throat and thus children will often complain of a sore throat when they have the common cold.

There are also a handful of viruses that cause sore throat as the primary symptom – things like Hand-Foot-and-Mouth Disease, Herpangina, and Mono. Remember that antibiotics are useless against these viruses.  If you insist on getting an antibiotic, or your doctor gives you an antibiotic when your child has a virus they will get absolutely no benefit but all the risks (like rash, diarrhea, and allergic reaction).

Myth #2: If my child has Strep throat, I need to get to the doctor immediately.

I am continually amazed at how many people show up at 2 am in the morning to have their child “tested for Strep.”  I often wonder what they think will happen between 2 am and 8 am when their doctor’s office opens up?  Let me assure you that letting your child get some rest at home and waiting until the next day to see the doctor is not going to result in any Strep catastrophe.

Of course there is all kinds of misinformation out there about scary things like Acute Rheumatic Fever and Paratonsillar abscess.  However, let me assure you that both of these things are very rare and it is unlikely that a trip to the ER in the middle of the night is going to play any role in their prevention.  However, a trip to the ER in the middle of the night will definitely deprive you and your sick child of much needed sleep and expose them to all the risks of being in the ER.

Myth #3: If my child has a positive Strep test they must get antibiotics.

Just because your child has a positive Strep test does not mean they have a Strep infection.  Depending on the time of the year, as many as 10% of normal healthy kids will have Strep in their mouth.  We all have bacteria in our nose and mouth.  In the right setting, these bacteria can cause an infection.  So just because the test is positive, it does not mean your child has an infection.  This is where so many doctors go wrong, in my opinion, and where the irrational medical practice begins.  Stay tuned and I will clarify this issue for you.

Myth #4: If my child is not treated for Strep, it won’t get better, and could spread to the heart.

So many false statements in this myth.  Like ear infections, almost all cases of Strep throat will completely resolve on their own.  Think about it… how did the human race survive before the advent of Penicillin just a short 50 years ago?  I will tell you how – people let their bodies fight the strep infection, and while this might be a shocker to some people, people actually got better!!!  You see, our body is very efficient at fighting off infections.  In fact, each time our body fights off an infection it actually gets a little stronger, this is called building immunity.  When your body builds immunity it can fight off the same infection better and faster the next time.

In rare cases, kids who have Strep throat can have an unusual reaction called Rheumatic Fever.  This is estimated to happen in somewhere between 3,000 and 30,000 kids who do not get antibiotics for their Strep infection.  Rheumatic Fever affects the heart about 10% of the time.  Thus some kids who get Strep throat and do not get antibiotics could have heart problems.  However,  if you do the math, this number is very small – somewhere between 30,000 and 300,000 kids.  Stay tuned to learn more about Rheumatic Fever.

Fact #1: If my child has Strep throat, antibiotics will make it better

This is true.  However, it is also true that your child’s own immune system will make Strep throat better.  Most people think antibiotics are a miracle cure.  They are not.  People with Strep throat who are treated with antibiotics will get better, on average, about 16 hours sooner.

Fact #2: Penicillin is the the best antibiotic for Strep

Strep is not like many other infections.  It is weak and very sensitive to Penicillin.  Penicillin is very specific for Strep infections and the best choice of medicine.  Using other more powerful antibiotics is a waste of money and a bad idea.  More powerful antibiotics have a much longer list of side-effects and should be reserved for more serious infections that are not sensitive to Penicillin.

Fact #3: Oral antibiotics are just as good as a shot.

I probably got about 10 shots of Penicillin when I was a kid. I am not sure why I always had to get the shot, but I can still remember how painful it was.  Now that I am a doctor I want to go ask my childhood doctor why he insisted on torturing me that way.  There is zero benefit to giving the Penicillin in a shot over giving it as  liquid.  Trust me, simply because you do not want to try and make your child take the medicine is NOT a good reason to subject your child to this very painful injection.

Fact #4: Your child is more likely to die from a serious allergic reaction than heart problems associated with a Strep infection.

True.  Depending on the statistics you look at, somewhere around 1 child in 100,000 who take Penicillin will die from a severe allergic reaction.  If you remember from above, somewhere between 30,000 and 300,000 children who have untreated Strep Throat will get Rheumatic Fever that affects the heart.  Roughly 10% of those kids will die.  So if you do the math, somewhere between 300,000 and 3,000,000 cases of Strep throat need to be treated to prevent one death.  Even if you take the low end of the statistics – 3 kids will die from a severe allergic reaction for every 1 kid you save from the ravages of Strep throat and Rheumatic Fever.  Those are just the numbers… I don’t make them up.

Of course there are some other complications associated with Strep throat and there are some times when you should probably treat Strep throat.  However, if your doctor tells you that they are treating the Strep throat to prevent the complications of Rheumatic Fever, well, the numbers just don’t add up.

Next Post

Read on to explore Strep throat in more detail.  There are times when I treat Strep throat and times when I don’t.  However, the idea that you need to take your kid in to the doctor at the first sign of sore throat is unfounded.  More, the practice that every kid with a sore throat needs a throat swab and a shot of Penicillin is profiteering off parental anxiety at worst and irrational medical practice at best.  So read on, evaluate the facts for yourself, and You Decide.

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