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Martin,
 
I would have to say that there are a lot in the medical profession who will
argue with this premise.  If a patient presents with a sore throat and it
"looks like Strept," it ought to be cultured.  If the culture (whether or
not it is Quick Strept), is positive, the treatment for that is antibiotics.
 
Whether or not the patient's immune system is fighting the infection is
another story.  We treat the patient, however, not the lab and there must
be a concommitant reason for the treatment.  "I think" that the patient's
history should be taken into account, i.e., whether or not the patient has
a history of rheumatic fever -- and the patient's age must also be taken
into consideration.  I don't think anyone would argue with treating Strept
in a pediatric patient.  The older patients (not geriatrics) should be
taken as a "patient by patient" consideration as to whether or not the
infection is treated.  If the patient is not doing well after three days of
not treating it, it would become a disservice to withhold treatment.
 
IMHO.
 
Mark
 
At 10:04 AM 9/17/98 -0700, Martin Oliver wrote:
>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
>
>For more information, send mail to [log in to unmask] with the
message: info PED-EM-L
>The URL for the PED-EM-L Web Page is:
>  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
>
>
Mark E. Abell, PA-C
Freelance Med-Write
2309 SE 5th Street
Ocala, Florida 34471
 
(352) 369-9702 (voice)
(352) 369-9703 (fax)
 
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html