Blog | 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.

tools of the trade by cjc4454 via Flickr/Creative Commons licensePersonally, 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.