WHAT TO DO WITH SORE THROATS AND TONSILLITIS…

Lots of people know that sore throats and tonsillitis can be caused by viruses or bacteria – Commonly Streptococcus or ‘Strep Throat’. You might also know we just need rest for most viruses and our body can handle them, but it may surprise you to know that not all bacterial infections need antibiotics.

Minimising antibiotic use helps protect our gut flora, problems with which are more and more being linked with bowel syndromes, inflammatory conditions, mood disorders and metabolic disease among others! In general, our aim is to use antibiotics only for serious infections that are not likely to resolve without antibiotics.

In the case of strep throat, antibiotics have been shown to reduce symptom duration by just 16hrs. That’s a small benefit compared to the effects of antibiotics on your system. So even if your throat swab is positive you probably don’t need antibiotics, in fact just because the throat swab is positive, doesn’t even mean the Strep bacteria are the cause of the sore throat. If you tested everyone, when their throat felt fine, a percentage of the population will be carrying strep bacteria in the throat… you might have it hanging out in yours, and your sore throat might just have been caused by a virus.

Both viruses and strep throat can give you a really sore throat, and make you feel unwell so we can’t tell from those things which it is.

When do we need to do a throat swab then?

These signs suggest a virus and throat swab is not needed:

• presence of cough,
• runny nose
• conjunctivitis
• hoarse voice
• <3yrs old

People with Strep throat will usually have multiple symptoms from the following list. In these cases a throat swab should be considered:

• High fever
• No cough
• Large tender glands in the front of the neck
• Pus on the tonsils
• Age 3-14yrs old.

Some patient groups are higher risk for rheumatic fever and should have a throat swab done if they have a sore throat – people with a personal , family or household history of acute rheumatic fever, or Maori/Pacific Islanders age 3-35yrs old.

Here at Wakefield Heath Centre, we hope you get through the winter without any sore throats in your family, though statistically that is unlikely – so if you are affected, think:

• Are there signs this is a virus? – if so rest up and wait it out, see your GP if you are getting more unwell or it is lasting for over a week without improvement.

• Is there a high risk of rheumatic fever? – book in with your GP to get checked.

• Do I have more than one item from the second list above? Consider seeing your GP to discuss if you need a swab/antibiotics. If you are not very unwell or a high risk ethnicity or 3-14yrs old, its fine to give it a few days first to see if your body handles it on it’s own.

References:

McIsaac WJ, White D, TannenbaumD, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ 1998;158(1):75-83