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Ears, Nose, Throat and Health

Sore throat, GAS infection

What You Should Know About The Sore Throat Card?

By Dr. W. Gifford Jones

January 21, 1996

Every year it happens several times to millions of North Americans. Someone in the household wakens with a sore throat. The dilemma is knowing what to do about it. Should you wait until nature cures it? Or is it prudent to see the doctor in case it's a prelude to serious disease? Now there's a sore throat card to help answer this common question.

  I've always believed in Sir William Osler's advice for a cold. He facetiously counselled his patients to put a hat on the end of the bed post. Then start drinking scotch until they saw two hats! Or Mother's advice about chicken soup. You can also take two aspirins and gargle, and call your doctor in the morning. Or now EªMail him in the morning!

  But I've always had a healthy respect for the sore throat. It can be a precursor of something more serious. Unfortunately it's not easy to know whether the symptom is due to group A streptococcus (GAS) infection or viral infection.

  For some patients the difference can be crucial. GAS infections have the potential to trigger an acute kidney infection, rheumatic fever or joint pain several weeks later.

  Dr Warren McIsaac, a researcher at the Institute for Clinical Evaluative Services (ICES) at University of Toronto, worked with family physicians in Stratford, Ontario to answer a basic question. When should doctors prescribe antibiotics for a sore throat?

  When doctors ask you to say "aah", how accurate a method is it for diagnosing a GAS infection? Dr Warren claims that physicians make this diagnosis up to 40 per cent of the time. But that only 10 to 20 per cent of these patients with a sore throat actually have a GAS infection.

  The sore throat card improves the accuracy of this diagnosis. It identifies those patients who are most likely to benefit from antibiotics.

  The score card asks four questions. Do patients have a fever of over 38 degrees C (101 degrees F), a cough, swollen, tender, lymph nodes in the neck or exudate on the tonsils.

  Patients with none or only one of these findings have a 2 to 7 per cent chance of having a GAS infection. In these cases the Institute does not recommend either a throat culture or antibiotics.

ICES decided this was a good cut-off point, since even throat cultures miss picking up GAS infections 10 per cent of the time.

  For patients with a score of two to three, a throat culture is recommended. But an antibiotic is advised only if the culture detects GAS infection.

  Patients with all four clinical findings need a throat culture. And the doctor can use his or her judgment whether antibiotics should be given immediately or whether to wait until the culture is reported. There is no increased risk of rheumatic fever if antibiotics are delayed for 48 to 72 hours.

  Patients who develop a sore throat often seek antibiotics for the wrong reason. They believe that taking an antibiotic will quickly cure the pain.

  Studies suggest that for sick, febrile children antibiotics may help to ease the discomfort. But this is not necessarily the case for adults. Rather, in the majority of patients with a strep throat symptoms subside in 3 or 4 days whether or not antibiotics are given.

  Dr. Warren says that doctors and patients have lost sight of the original reason for treating strep throat with antibiotics. The reason was never to ease the pain. Rather to prevent the potential complications of a GAS infection.

  What is the risk of rheumatic fever if you do nothing? Not as great as in the past. The incidence of rheumatic fever in the general population is low. Luckily it has dramatically declined during the last 40 years.

  Remember that the majority of sore throats are due to virus infections. In these cases it doesn't matter if you take vitamin C, antibiotics or practice yoga. Antibiotics have no effect on viruses. Tincture of time is the only medicine that eases a viral throat infection.

So what to do? Unlike the common cold I think it's prudent to see your doctor. He may tell you to do nothing. But if a throat culture shows a strep infection, penicillin is the drug of choice. If you're allergic to this antibiotic, erythromycin is available.

  Once you start penicillin be sure to use it the right way. It should be taken on an empty stomach. There's also a great temptation to stop penicillin after 48 hours when you feel better. But to be effective it must be taken continuously for 10 days.


W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones
Canada Free Press, CFP Editor Judi McLeod