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Why treat strep with antibiotics at all?
 
I apologize for not having the references handy (I've been following
this thread for 3 days, and still can't find them). I'm a PA, trained at
and previously employed at at LAC+USC.
 
Strep pharyngitis is a self limiting illness (unless they're chronic
carriers). We treat strep with abx to prevent rheumatic fever/heart
disease. PCN rx does not prevent subsequent AGN. One in 1.5 mil (or
something - I don't remember the exact number) will develop rheumatic
fever.
 
1/150,000 will develop an allergic reaction to PCN.
 
It's easy to throw antibiotics at something, because it satisfies the
customer/patient, and it satisfies us, and it satisfies the lawyers.
 
I work with 17 supervising docs, who all agree on how to treat a heart
attack, but a sore throat...
 
I personally treat homeless/care less folks with LA Bicillin IM, and
promise to meet them in triage, without signing in, in 2 days (to check
for abscess). The rest I culture, give ibuprofen and hydrocodone syrup -
because it worked for me - and prednisone if they're real bad.
 
BTW, I recently rapid-strep'd an 18 month old who was positive,
confirmed by cx (unusual for us)
 
Martin Oliver, PA-C
Capistrano Beach, CA
 
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