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One more thought,
 
Although we acknowledge that the rational for treating strep is generally
given to be to prevent ARF,, Harvey is absolutely on the money with his
comment regarding shortening the duration of symptoms. Hence In patients
that seem to be infected ( not asymptomatic carriers) treatment actually has
2 things in its favor. When I throw into the mix that other bacteria
 ieMycoPlasma sp., H. flu, other Lancefield Group Strep,)  can cause
exudative pharyngitis, I begin to question whether or not, given the
vagaries of the rapid strep ( swabbing the tonsils vs tongue, etc,
sensitivity /specificity, ) that perhaps antibiotics would help all of these
patients (infected with strep and those other agents), I tend to lean
towards treating symptomatic exudative pharyngitis in patients,. unless they
appear to have a clear viral etiology ( like Infectious Mono)
 
I do not give IM Penicillin however unless I have a positive strep swab
 that someone else obtained), the patient has scarlet fever or someother
compelling reason to resort to injection(inability to get medication,
persistent vomiting)
 
As an aside, even though the incidence of anaphylactic reactions to pen are
rare, I did have an 18 year patient die from one when I was a resident., and
that has tempered my use of this agent. ( Patient was a healthy 18yo, seen
for exudative pharyngitis, cultured and sent home.. The culture turned
positive the next day, the patient was called back into the ED and given
herinjection of CR Bicillin 900/300.. We observed for 30 minutes, and she
was discharged with normal VS..She collapsed in thep arking lot, and was
unable to be resuscitated!)
 
 
 Just some fuel for thought..
Martin
 
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