What’s the best treatment for most sore throats?
Pediatricians commonly see children with sore throats, but it's usually only in the case of strep that an antibiotic is given for treatment.
Editor's note: This is part of an occasional series on evidence-based medicine.
When adults are ill, you'll find a wide range of attitudes about their need for medical care from "I will just tough it out" to "GIVE me medicine right now!!" On the other hand, when children are ill, everyone tends fall under the "fix them now with medicine" end of the spectrum.
A common problem that pediatricians see is the sore throat and if parents bring a child into the doctor (or nowadays call, email, or tweet), most of these parents want their children to have antibiotics. Then they get confused when we say "no" to antibiotics until we prove it is a strep throat.
Antibiotics can be miracle drugs. Strep throat's after effect is usually very mild now, but it still can cause the severe heart and kidney diseases that were described over 100 years ago as "the curse of our school children." Antibiotics and environmental factors (such as improved nutrition and sanitation) have greatly reduced the incidence of both rheumatic heart disease and post-streptococcal glomerulonephritis (a severe kidney disease) that untreated Group A beta hemolytic streptococcus germs can cause. Treating group A beta hemolytic prevents rheumatic heart disease, but actually does not prevent post-streptococcal kidney disease
In fact, there is more disease from the side effects of the antibiotics today (allergic reaction, diarrhea, changes in the normal germs found in the patients' gut) than from this strep germ directly. So the best medical care is to only treat sore throat caused by this very dangerous germ.
When your child has a sore throat without cold symptoms, especially with a bad headache or stomach pain, the medical practitioner will check to see if your sick child with a sore throat has a Group A Beta Hemolytic streptococcal (strep) infection rather than some other germ. There are many types of strep germs divided into "types":
A to G primarily infect human beings with Group B being very dangerous to newborns
Sub-types. Only one sub-type of one type, the type A, beta-hemolytic mentioned above causes heart and kidney disease.
If a doctor suspects a strep infection, a two part test will be used to confirm it or not. Why we do a two-step test for strep throat requires a little statistics and understanding the terms: "specificity" and "sensitivity".
The rapid strep can be done in the office in less than 10 minutes. The rapid test is very specific (98 percent), but only moderately sensitive (about 75 percent). In plain language, 98 percent specific means that if the rapid test is positive the child does have the strep we worry about 98 percent of the time and we have to treat them. We are over-treating one out of 50 (2 percent), but that is not many.
If the rapid test is negative, the child does not have the bad strep 75 percent of the time, but still might have it 25 percent of the time. Knowing this, we send the throat swab to a commercial laboratory and find out the results within 72 hours. This gives the doctor time to treat the strep before it causes secondary disease. If the culture is positive, the medical provider calls the pharmacy and prescribes antibiotics.
The other causes of sore throat almost always get better by themselves and do not cause serious side effects. If the illness persists, the doctor will look for other causes of sore throat like staph aureus (the cause of skin infections and abscesses) or gonorrhea (a sexually acquired disease).
Back in July, I said I would talk about how statistics and how the lack of understanding of these numbers leads to bad medicine. Germs, like people, change over time. Doctors want to keep strep germs sensitive to penicillin and other simple, effective and relatively cheap antibiotics. The best way to preserve the effectiveness of antibiotics is to only use them when they are absolutely necessary.
If we expose germs to antibiotics too often, the germs will get resistant and the antibiotics will no longer work. Many parents, seeing their children suffer want them better right away and many are facing the stress of missing work to take care of them. They want antibiotics for every illness even though most illnesses are caused by viruses that do not get better with antibiotics. So knowing about sensitivity and specificity helps doctors know how to take best care of your child. Next time, we will talk how not understanding these concepts can lead to bad medicine.
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