Rethinking Antibiotics for Strep Throat

Are antibiotics necessary when you have strep throat? Here’s a different way of thinking that challenges the status quo.

I was sitting in a lecture from a highly published infectious disease doctor. He had been around the world, treating crazy infections and researching diseases we have only heard of in textbooks.

But his main research focused on rheumatic heart disease, a condition thought to be directly related to infection by Streptococcus pyogenes, or Group A Strep, the bacteria that causes modern-day strep throat.

The basic premise is that the antibodies you create for strep attack one of your heart valves, which can have serious consequences for your health. So in theory, if you kill the strep with antibiotics before creating antibodies, you can prevent those downstream problems.

You’d think that the lecture would lead down the line of, “I’ve seen rheumatic heart disease and it’s bad. We should be treating every strep throat with antibiotics as soon as possible.”

BUT IT DIDN’T. INSTEAD, THE LECTURE FOCUSED ON WHY THE RISK OF RHEUMATIC HEART DISEASE IS EXTREMELY LOW IN THE DEVELOPED WORLD AND WHY ANTIBIOTICS MAY NOT BE NECESSARY FOR STREP THROAT.

In fact, if you look at the history of rheumatic heart disease and when the disease came to light, it was a case report, PREVENTION OF RHEUMATIC FEVER, published in JAMA in the 1950s regarding a military base that saw a significant number of cases in a very short time. They decided to treat everyone with antibiotics and found that for every 50–60 cases of strep, they could prevent 1 case of rheumatic heart disease. This case series became the impetus for antibiotic use.

Before this and subsequent studies, strep throat was not considered a health hazard as the country was concentrating more on Diptheria. Once this was under control, a new craze started to treat all cases of presumed strep throat.

But what is the actual evidence behind this treatment protocol except for the military base study?

The answer is that there is none. In all of the studies performed to date, including multiple studies that use randomized placebo and antibiotics, there have been none that have linked strep throat to rheumatic heart disease in this country in the past 60 years.

Why is this the case?

Some postulate that the strains of strep in the developed world are not as virulent to cause rheumatic heart disease. Others say that nutrition, hygiene, population crowding, or access to care may prevent this disease, while in 3rd world countries, the disease is still highly prevalent.

Either way, nothing points to antibiotics as the cure.

So you ask, what would happen if you don’t take antibiotics for a throat infection?

The answer is fairly simple — probably nothing, based on the evidence.

Most throat infections are viral, at least above 90%, and these will be fought off by the body’s immune system. Antibiotics do not help these infections and add to the growing bacterial resistance problem in the world, not to mention the devastation to our microbiome (which could be much more disastrous to humans than any other problems we face — but I digress).

Of the infections that are bacterial, Streptococcus A is the main one that we treat. Before antibiotics, people got the infection, their immune system kicked in, and they fought off the bacteria. This would likely be the case for most people today.

You ask, doesn’t the antibiotic make the infection go away more quickly if it truly is strep throat?

A Cochrane Review article shows that antibiotics decrease symptom duration by about one day. However, other studies have shown that ibuprofen, acetaminophen, or steroids have similar effects. Food for thought…

Others might ask, doesn’t treatment of strep with antibiotics prevent kidney problems such as post-streptococcal glomerulonephritis?

Once again, no studies have shown that treatment with antibiotics actually prevents this condition. Patients who have this consequence of a strep infection could potentially get this condition whether treated with antibiotics or not.

Final Thoughts

1. Most throat infections are viral and require no antibiotics. THEY WILL GET BETTER ON THEIR OWN.
2. Antibiotics have not been shown in studies to prevent rheumatic heart disease or glomerulonephritis in the developed world.
3. Antibiotics AND pain medications equally decrease the duration of symptoms.
4. Rheumatic heart disease is still highly prevalent around the world and deserves attention to study why it occurs and how to rid humans of this disease.

I don’t claim to have all of the answers and I am not advocating to change the current guidelines regarding treatment of strep throat. I am simply stating the evidence and giving a different way of thinking, one that challenges the status quo and asks us to think of WHY we do what we do. Antibiotics are a serious health hazard to our world. While they kill bacteria that cause severe infections, they also may be the cause of many other diseases and allergies we see in society today. Many times they are not necessary and they are certainly overprescribed in today’s society.

I don’t see the United States changing its recommendations regarding strep throat anytime soon.

And to be honest, if I was given a decision whether or not to treat my own children, I would.

We live in a world where we weigh the risks and benefits of a given treatment. And we would feel guilty if we made the wrong decision, going against societal norms. But our world will change because it must in order to improve health. I hope this article helps you see a different point of view.

What do you think about strep throat treatment? Please comment below.