Can strep throat resolve on its own?

Can Strep Throat Resolve on Its Own?

While strep throat can resolve without antibiotics in some cases, treatment is strongly recommended to prevent serious complications such as rheumatic fever and suppurative complications.

Natural Course of Strep Throat

• Group A streptococcal (GAS) pharyngitis is often a mild and self-limiting infection even without antimicrobial therapy 1.
• The symptoms of strep throat (fever and pain) typically improve within 3-4 days in about 50% of untreated patients, and by one week, approximately 90% of both treated and untreated patients are symptom-free 2.
• However, spontaneous resolution does not eliminate the risk of serious complications 3.

Risks of Untreated Strep Throat

Non-Suppurative Complications

• Acute rheumatic fever (ARF) is a serious potential complication that can be prevented by appropriate antibiotic treatment 3.
• Studies from the 1950s showed that antibiotic treatment reduced the risk of acute rheumatic fever by approximately 75% 4.
• Treatment within 9 days of symptom onset is effective in preventing ARF 3.

Suppurative Complications

• Untreated strep throat carries a risk of suppurative complications including:
  • Peritonsillar abscess (quinsy) - risk reduced by 85% with antibiotics 2
  • Acute otitis media - risk reduced by 70% with antibiotics 2
  • Acute sinusitis - risk reduced by 52% with antibiotics 2

Benefits of Antibiotic Treatment

• Antibiotics accelerate symptom resolution by approximately 16 hours compared to no treatment 2.
• Antibiotic therapy reduces the duration of contagiousness and limits spread of the infection to family members, classmates, and other close contacts 3.
• Treatment allows for earlier return to school or work 5.

Treatment Recommendations

• Penicillin remains the treatment of choice for GAS pharyngitis due to its proven efficacy, safety, narrow spectrum, and low cost 3.
• For patients allergic to penicillin, appropriate alternatives include:
  • First-generation cephalosporins (for those without anaphylactic sensitivity) 3
  • Clindamycin or clarithromycin for 10 days 3
  • Azithromycin for 5 days 3

Special Considerations

• The risk of rheumatic fever is extremely low in adults, even with untreated streptococcal pharyngitis 3.
• Children under 3 years of age have a low prevalence of GAS pharyngitis and low risk of developing ARF 3.
• In areas where rheumatic fever remains prevalent (particularly in poor and crowded inner-city populations), treatment is especially important 5.

Conclusion

While strep throat symptoms may resolve on their own within a week in many cases, antibiotic treatment is still recommended to:

1. Prevent serious complications, particularly rheumatic fever 3
2. Reduce the duration and severity of symptoms 2
3. Prevent spread of infection to others 3
4. Allow earlier return to normal activities 5

The absolute benefits of antibiotics may be modest for symptom relief, but the prevention of serious complications justifies their use in confirmed cases of strep throat 2.