A review published in December 2017 in PLoS Biology suggests that antibiotic prescriptions for some infections are contributing to the growing problem of antibiotic resistance and superbugs. Researchers found that most prescriptions written for antibiotics in the United States are for clinically mild conditions, such as strep throat, urinary tract infection, and otitis (swimmer’s ear). The study authors suggest developing alternatives to antibiotics to treat infections like strep throat and leaving antibiotics for more severe infections. “If we want to save lives we have to develop alternative drugs for those mild infections,” says Kristofer Wollein Waldetoft, a postdoctoral fellow in the division of infectious medicine at Lund University in Sweden and a coauthor of the paper, “and reserve antibiotics for infections that kill people, like sepsis.” “People should hope that their doctor does not prescribe an antibiotic,” says Aaron Glatt, MD, the chairman of medicine at South Nassau Communities Hospital in Hewlett, New York, and a spokesperson for the Infectious Disease Society of America. “They also shouldn’t expect a prescription every time they visit their doctor.” Glatt says that people need to change the way they think about doctor visits. They should go to a doctor for a diagnosis and a recommendation on how to treat an illness, not to always walk away with a prescription in hand. It’s also important to remember that antibiotics can have side effects, and patients may even have allergic reactions to them. Antibiotics can also be expensive, especially if you do not have insurance and have to pay with cash, says Dr. Glatt. “It has to be the right person, the right time, and the right drug,” said Glatt. “There’s a lot of overdiagnosis for strep throat that leads to overtreatment,” says Stanford Shulman, MD, one of the authors of the 2012 guidelines for strep throat diagnosis and treatment by the Infectious Diseases Society of America (IDSA). Dr. Shulman, a doctor at the Ann and Robert H. Lurie Children’s Hospital and a professor at Northwestern University’s Feinberg School of Medicine in Chicago, says there’s some confusion over the diagnosis of group A strep throat. Often, a large number of people who are carriers of the bacteria don’t need to be treated. And a sore throat doesn’t automatically mean you have a strep infection. A patient may come in with a sore throat along with cold symptoms, such as a cough, runny nose, pink eye, or a raspy or strained voice. With those symptoms, it’s more likely he or she has a viral infection, for which an antibiotic would be useless.
How to Know When Antibiotics Are Necessary
Strep throat is common in children because it’s easily spread through a sneeze, cough, or sharing food, among other ways. Watch out for these symptoms:
A feverSore throat that causes pain when swallowingSwollen tonsils with pusAbsence of coughSwollen lymph nodes
Some children may feel nauseated, have a headache or a stomachache, or vomit. A number of children with these symptoms may have scarlet fever, a fever accompanied by a rash. Doctors have to be selective about testing for strep throat, says Shulman. Strep throat is not diagnosed just by symptoms: There are two tests used to confirm it. The doctor or medical professional takes a throat swab, called a rapid strep test, or a throat culture. If the test comes back positive for the bacteria, then the doctor will usually prescribe an antibiotic. But strep throat is a self-limited disease that will go away on its own, says Shulman. Antibiotics are not prescribed to treat strep itself, but to prevent serious complications, such as rheumatic fever. Also, after the initial 24 hours of taking antibiotics, people can go back to work or school because they’re not considered contagious anymore, though their symptoms may take a little longer to subside. “Patients should actually ask if they really need to take an antibiotic,” says Waldetoft. “Over here [in Sweden] we are very concerned with antibiotic resistance and try to use narrow spectrum antibiotics whenever we can.” Narrow spectrum antibiotics, which the authors of the review recommend for treating certain cases of strep throat, are limited in the number of bacteria targeted and will not affect as many of the normal bacteria in the body. The IDSA guidelines recommend narrow spectrum antibiotics such as penicillin. Penicillin is the treatment of choice, and strep bacteria hasn’t been found to be resistant to it. (Waldetoft shared that his research did find that penicillin isn’t effective in urinary tract infections because of bacterial resistance.) Amoxicillin is considered to be a broader spectrum antibiotic, so it will kill more bacteria than penicillin. Right now, total elimination of antibiotics for treatment of strep throat is not an option, because there are no real replacements. But it is well worth considering alternatives, because there are other consequences of antibiotic overuse for people down the line, says Waldetoft. In the meantime, we wait for government agencies and pharmaceutical companies to develop alternative therapeutics. The World Health Organization (WHO) has a number of programs that address antibiotic resistance. By 2023, it aims to develop new treatments through the enhancement of existing antibiotics and development of new antibiotic drugs. If someone feels ill he or she should definitely consult a doctor. The important thing is not to expect or demand an antibiotic every time you get a sniffle — and never, ever, try to self-medicate with antibiotics. “Antibiotics are wonderful when they are needed,” says Shulman. “We don’t want to overuse them.”
