Friday, March 18, 2011
Should doctors treat asymptomatic strep throat?
Occasionally, I see patients who have received throat swabs for strep that have come back positive ... even if they have no signs or symptoms of pharyngitis.
In this situation, there are two main actions a physician may take (I am biased toward one):
1) Prescribe antibiotics until throat cultures are normal.
2) Do nothing.
Personally, if a patient is without throat symptoms and has no history of rheumatic fever or kidney damage, I would not have even bothered obtaining a strep test. What for?
Also, a person can be a carrier for strep without suffering any health problems. As such, even if the strep test is positive, but if the patient has no symptoms, I do not recommend treatment (which again begs the question of why bother getting a strep test if no treatment will be recommended regardless of the test result).
I would go so far even to say follow-up cultures are not necessary after antibiotic treatment for strep throat if a patient does not have any more symptoms and exam is normal, which is why I find it surprising when children and adolescent patients receive multiple courses of antibiotics when they feel perfectly fine, but have received treatment just because a strep test came back positive.
Of course ... that's just my opinion as I do acknowledge that there's another school of thought which supports antibiotic treatment of all strep positive cultures with follow-up cultures to ensure eradication.
This post by Christopher Chang, MD, appeared at Get Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.
Labels: antibiotics, drug resistance, evidence-based medicine, infectious diseases
posted by the Better Health network at
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4 Comments:
Doctors should not be screening or treating for strep in asymptomatic patients. I see this quite frequently, a child will be diagnosed with strep and treated. Consquently, their parents are swabbed due to the contact with their child despite lack of symptoms. Many of these people are clearly colonized and then subsequently treated. Oh, did I mention that I am an allergist who then needs to explain their drug reaction to a drug they probably didn't really need?
Can you please explain in a little bit more detail as to why asymptomatic strep is not harmful to the carrier and to other people in his or her surroundings?
There was a case of asymptomatic strep in our day care and the owner is pushing for everybody to get tested. I, however, feel somewhat reluctant to do so - it just seems strange and illogical to test and potentially even treat somebody with no visible problem. but I'd like more hard evidence. Thank you.
It is my understanding that a strep infection can damage heart valves over time. If this is true, then the strep infection may not be truly asymptomatic.
I am not a doctor - but this is the most ludicrous thing I ever heard.
If a person has asymptomatic strep throat then they STILL have strep throat, correct? And that strep can be transmitted to others - correct?
By not treating an asymptomatic strep throat, you are exposing others to risk - especially if the carrier is a popular young man or woman who is engaged in kissing various people over the course of a year.
It seems to me that a doctor would feel LUCKY to discover an asymptomatic carrier "by chance" and would do everything possible to stop the spread of strep.
Whatever happened to "do no harm?"
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