From the Guidelines
No, bacterial strep throat should not be allowed to heal on its own without antibiotics, as treatment with antibiotics is necessary to prevent serious complications such as rheumatic fever and reduce symptom duration. According to the most recent and highest quality study 1, antibiotics like penicillin V (500 mg twice daily for 10 days) or amoxicillin (500 mg twice daily for 10 days) are strongly recommended for the treatment of streptococcal pharyngitis. For individuals with penicillin allergies, alternatives such as azithromycin (500 mg on day 1, then 250 mg daily for 4 more days) can be used. The use of antibiotics helps to prevent serious complications, reduce symptom duration, and decrease contagiousness within 24 hours. While most people would eventually recover from the throat infection itself without treatment, the risk of potentially serious complications makes antibiotic treatment necessary.
Some key points to consider when treating streptococcal pharyngitis include:
- Completing the full course of antibiotics even if symptoms improve
- Staying hydrated and resting to help the body recover
- Using over-the-counter pain relievers like acetaminophen or ibuprofen for symptom relief
- Being aware of the potential for antibiotic resistance and the importance of proper antibiotic use
It's also important to note that the diagnosis of streptococcal pharyngitis should be confirmed by culture or rapid antigen detection test (RADT) before initiating antibiotic treatment, as recommended by the Infectious Diseases Society of America 1 and the American Heart Association 1.
In terms of specific treatment regimens, the 2012 update by the Infectious Diseases Society of America 1 provides guidance on the use of various antibiotics, including penicillin, amoxicillin, and azithromycin, as well as the use of alternative agents for individuals with penicillin allergies.
Overall, the use of antibiotics is a crucial component of the treatment of streptococcal pharyngitis, and antibiotic treatment should not be withheld in favor of allowing the infection to heal on its own.
From the Research
Allowing Bacterial Strep to Heal on its Own
- The decision to allow bacterial strep to heal on its own without antibiotics depends on various factors, including the severity of symptoms, patient age, and risk of complications 2, 3, 4.
- Guidelines recommend using clinical decision rules to assess the risk of group A beta-hemolytic streptococcal infection, followed by rapid antigen testing if a diagnosis is unclear, before prescribing antibiotics 2, 3.
- Studies suggest that only 10% of adults seeking care for a sore throat have group A beta-hemolytic streptococcal pharyngitis, and 60% or more are prescribed antibiotics, indicating potential overuse of antibiotics 2.
- The use of antibiotics is recommended for patients with a positive rapid antigen test result or throat culture, and penicillin and amoxicillin are first-line antibiotics, with a recommended course of 10 days 2, 3, 4.
Risks and Complications
- Complications from group A beta-hemolytic streptococcal pharyngitis include rheumatic fever, deep space abscesses, and toxic shock 5.
- Chronic streptococcal pharyngitis can occur, and non-infectious etiologies, such as laryngopharyngeal reflux and periodic fever, aphthous ulcers, pharyngitis, and adenitis syndrome, should also be considered 5.
- The risk of contagion and the potential for nonsuppurative and suppurative complications should be taken into account when deciding whether to treat with antibiotics 6.
Diagnostic Methods and Treatment
- Diagnostic methods, including clinical scoring systems, rapid antigen detection tests, throat culture, nucleic acid amplification tests, and machine learning and artificial intelligence, can be used to diagnose group A beta-hemolytic streptococcal pharyngitis 6.
- Treatment for group A beta-hemolytic streptococcal pharyngitis using analgesics, antipyretics, and antibiotics seeks to provide symptom relief, shorten the duration of illness, prevent complications, and decrease the risk of contagion, while minimizing the unnecessary use of antibiotics 6.