Shulman Helps Revise Strep Throat Guidelines
When it comes to strep throat, the good news is, you probably don’t have it.
That was a part of the findings by Stanford Shulman, MD, professor in pediatrics, and an expert panel of the Infectious Diseases Society of America (IDSA) after reviewing hundreds of studies over the past two years.
About 15 million people in the U.S. see their doctor for a sore throat every year and up to 70 percent receive antibiotics, although only 20 to 30 percent of children and five to 15 percent of adults actually have strep throat. That means millions of individuals received antibiotics they didn’t need.
“Over time we have realized that physicians have overtreated patients with sore throat, most of which are viral and don’t need antibiotics,” said Shulman, guidelines panel chair. “Overtreatment leads to resistant bacteria, so testing is necessary to exclude those without strep.”
The IDSA’s revised guidelines for Group A streptococcal pharyngitis – strep throat – advise that when a strep infection is confirmed by testing, it should be treated with penicillin or amoxicillin, and not azithromycin or a cephalosporin.
“We recommend penicillin or amoxicillin for treating strep because they are very effective and safe in those who are not allergic, and there is increasing resistance of strep to the broader-spectrum – and more expensive – macrolides, including azithromycin,” Shulman said. “Treatment options have changed, so now once daily amoxicillin for 10 days is very convenient.”
Further, the guidelines recommend that children who suffer from recurrent strep throat should not have their tonsils surgically removed solely to reduce the frequency of infection. And they note that children and adults do not need to be tested for strep throat if they have a cough, runny nose, hoarseness and mouth sores, which are strong signs of a viral throat infection. A sore throat is more likely to be caused by strep if the pain comes on suddenly, swallowing hurts, and the sufferer has a fever without the above listed features, but should be confirmed through testing before antibiotics are prescribed.
“We hope that these guidelines will help clinicians avoid prescribing antibiotics to those with sore throat who don't have strep,” Shulman said.
The eight-member Group A streptococcal pharyngitis guidelines panel comprises experts representing a variety of specialties, including adult and pediatric infectious diseases physicians, pediatricians, and respiratory diseases authorities.
The guidelines were published in the journal Clinical Infectious Diseases, with Shulman as lead author.