NEED AN ANTIBIOTIC - NOT ALWAYS

    Marvin M. Lipman, M.D. tells about a disappointed patient, a 50-year old stockbroker who came to see him with a four-day history of a sore throat, coughing, postnasal drip and low-grade fever.  He said his previous physician had always given him a Z-Pak (a five-day course of antibiotic azithromycin) for similar symptoms and he always got better.  I explained that it was more likely that he had a viral infection for which an antibiotic would be useless.  I outlined some over-the-counter drugs that might be of help.  He left the office in a huff and I never saw him again.

     The age of antibiotics began in the 1930s with the introduction of sulfa drugs followed by penicillin in 1941.  During the last century, antibiotics saved the lives of countless millions of people infected with the deadly bacteria.  The war against viruses, with a few notable exceptions, has not been as successful.  Physicians began writing antibiotic prescriptions “just in case” bacteria might also be involved.  Patients came to expect and even demand such treatment.  Unnecessary antibiotics not only exposes patients to harmful side effects, such as debilitating diarrhea, but also led directly to the emergence of resistant strains of bacteria that then went on to infect others.

         Untreated sore throats can appease miserable patients desperate for a quick cure, but the practice dates back to a time when untreated sore throats were followed by rheumatic fever or acute kidney disease.  Strep throat accounted for only 5 to 15 percent of all sore throats.  Today, there is no need to give antibiotics “just in case” it is strep.  The organism can be reliably detected with a simple throat swab, with results available within 24 hours.  The disease can almost always be distinguished from a viral sore throat on clinical grounds alone.  The patient is usually less than 50 years of age and the sore throat can come on quickly within hours or overnight, making swallowing so difficult that drooling can occur.  The breath has a foul odor, and even speech is affected and a temperature of over 101 degrees F., accompanied by chilly sensations.  One can easily notice tender swollen lymph nodes under the jaw, and yellowish pus overlying the tonsils.  A strep evidently lacks the ingenuity to have developed resistance so penicillin is still the mainstay of treatment unless one is allergic to it.  Throat lozenges, gargling with warm salt water and of course the good old chicken soup treatment would have helped my stockbroker more.