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Doctors' Answers to "Frequently Asked Questions" - Strep Throat

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 04/20/2000]
Question: My daughter has been diagnosed with Staph B and is on penicillin. What is Staph B and what causes it?

Answer: I think you mean Strep B, there is no Staph A that I am aware of. This is a type of streptococci bacteria which is usually present in the oral flora(usual bacteria) of the mouth. Often a pathogen in newborns and post-partum women, what is she being treated for? Penicillin is usually effective, sensitivies need to be performed like with any bacteria depending on the severity of the problem.

Culturing After Multiple Strep Throat Recurrences
Question: Thank you so much for replying. My doctor doesn't see me. He just prescribes the drugs. Now it is the 4th time the strep has come back. I am on Augmentin 500 for a month. The second time I had it I had everyone cultured in the house and no one had it. Also this last time was strange. I had a sore on the side of my tongue two weeks after finishing the antibiotic. Since the third time I got strep I had this sore on the side of my tongue and then shortly after got strep, I decided to have a culture. Two days after the throat culture I got the strep in my throat. It was exactly as it felt the previous times so I knew it was strep. But the funny thing is my throat culture came out negative . So my point is, can a culture really detect strep unless you have a full blown case in the back of your throat. How could my culture come out negative when I got it two days later. My tongue had the sore, so the strep must have been active, but the culture didn't catch it. So if someone in the house is carrying it but doesn't have a "case" then will the culture really find it?

Also, your previous comment about abscess in the tonsils rings a bell. Because I have these little folds in my tonsils where white stinky stuff collects. Here is another thought. I was taking Flonase nasal spray for my allergies. I read something about recurrent strep being caused by the fact that the good flora in the throat that normally would control the strep is missing. So my thought was that the Flonase could be interferring with the good flora. I stopped the nasal spray with this suspicion in mind. I get rid of toothbrushes. And I changed the flonase bottle in case the tip was infected and this stuff didn't seem to make a difference. In fact would you believe my doctor said you don't need to get rid of the toothbrush because the chlorine (or something) in toothpaste kills any germs on a toothbrush. It is comforting to know that I won't get rheumatic fever. Thank you so very much for your information.

Answer: Strep cultures will miss about 15-20% of the time in controlled studies. Has your md done a viral culture? This could be recurrent oral herpes with a different presentation. I do have one patient who continues to develop strep infections and we have never found the answer. By the way, if your md thinks that the chlorine in toothpaste will control the bacteria, I would find another md. Lastly, did you culture the dog? Dogs can be carriers also. Sometimes easier to just treat them. Good luck.

Strep Throat Recurrences
Question: I am 36 years old, I've had a positive throat culture for strep for the 3rd time since July 1st. The first time I was on amoxicillan, 2nd time on penicillin, and now I'm on Augmentin 875 for 10 days. My question is this....Should I be on Augmentin longer than the 10 days since there is an obvious problem with getting rid of this germ. When should I follow up with the doctor to see if it's been irradicated or should I just wait until I get a sore throat again as I've been doing. Also, what are my chances of getting Rheumatic heart disease or liver damage from having this strep in my system for so long. Should I get any screening tests at this point to check for any of these diseases? Thank you in advance for answering the question.

Answer: People after the age of 25 rarely develop Rheumatic Fever unless they have previously had Rh Fever as a child or young adult. What is the cause of your recurring infection? Usually, it is reinjection from someone close who is relatively without symptoms. Children, husband, boyfriend etc. Even dogs. Dogs can be carriers of Strep. Treat everyone in the house, or culture everyone in an attempt to find the culprit. Also, tonsils with absesses are common sources on inability to clear up the infection. If so, usually means a tonsillectomy even at 36.

Strep Throat Diagnosis
Question: How would you diagnose someone with strep throat?

Answer: A culture is the best way. One can assume from clinical indications, but this is not accurate.

Strep Throat Treatment
Question: What are the treatments for strep throat?

Answer: Antibiotics known to be bactericidal to Strep species. These include penicillin(and its cousins), erythromycin(and other macroglides), and tetracycline(last and least effective). Some use the quinolones, but I don't advocate this since sufficient studies in Strep throat haven't been performed. The antibiotics will need to be taken for a minimum of ten days to avoid the sequelae of scarlet fever or Rheumatic Fever (the purpose of the antibiotics).

Bacterial Strain
Question: Which bacterial strain causes "strep throat" and what are the common drugs (antibiotics?) used in it's treatment? Does the drug amoxilin have any effect in the treatment?

Answer:Strep throat is caused by a class of bacteria called Streptococcus There are many different strains of bacteria in this family-some can cause Rheumatic Fever the bother some sequelae of "strep throat". Penicillin is the main stay of treatment. In general, children and adults to about 25, and adults with previous histories of Rheumatic Fever are treated for all strep throats, Amoxicillin is a penicillin like drug.

Repeated Infections
Question: My niece has had 6 strep infections and 3 ear infections in the last 6 months. She has been sick off and on over the last 3 years with various forms of infections. When my niece was 3 she suffered some sort of life-threatening disease--my sister could not give me an exact name ...something like "henichshishalian"? It took my niece approx 1-1/2 years to recover from it - my sister was required to take urine samples 3 times a day for 6 weeks - whatever it was, it was attacking her kidneys. About 3 months ago, she developed a particularly nasty infection--her throat was full of pus, her temp was spiking at 104-105, and her joints were swollen with strange yellow and/or purple lumps all over her legs. The back of her head was swollen. She was rushed into hospital and treated - again, my sister couldn't give me the details (very frustrating). My niece has, for the last 2 weeks, developed yet another infection in her throat, and the doctors suspected meningitis... then they suspected glandular fever...? I am VERY concerned. They gave her a prescription for 7 days of erythromycin and this is not helping... I asked my sister if they had taken any kind of blood tests and instructed her in helping to prevent strep... she said no. I know this is very sketchy, but, being a lay person, I looked up the different kinds of Strep and Group A Strep seems to fit her symptoms exactly. Can you suggest a course of action? Should blood work be taken... What should the doctor be doing for my niece. She has absolutely no quality of life and is in constant paid. She has lost an incredible amount of weight and I fear for her well-being, if not her life. All this is taking place in the highlands of Scotland - can you please suggest a course of action. Little Jody needs help.

Answer: Hard to tell what her original problem was ;but, erythromycin is a very effective treatment for strep infections so I doubt that this is the problem. If your sister will ok it I would discuss her problem with her physician since there are major pieces of the puzzle that you do not have. If she will not ok this then you are probably doomed to frustration.

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