Shocking Revelations About Strep Throat

This is a bit off the topic of sleep apnea, but definitely relevant for everyone. I just finished reading Dr. David Newman’s book, Hippocrates’ Shadow:What Doctors Don’t Know, Don’t Tell You, and How Truth Can Repair the Patient-Doctor Breach. It was an eye-opening book, confirming my suspicions that many of the routine forms of therapy that we as doctors prescribe are more based on tradition or flawed logic than real science.

One shocking example is our obsession with treating Strep throat with oral antibiotics. The main reason why treatment is recommended is to prevent rheumatic fever. In the 1940s on an army base, there was an epidemic of streptococcal infections and rheumatic fever, which can lead to heart disease. By treating with antibiotics, they were able to lower the incidence of rheumatic fever from 2% to 1%. Calculations showed that they had to treat 50-60 soldiers to prevent one case of rheumatic fever.

Now that rheumatic fever is almost nonexistent, it’s estimated that you need to treat 1 million people with strep throat to prevent one case of rheumatic fever. What most doctors don’t realize is that every time you give antibiotics, you have a 10% chance of developing a rash, 10% chance of having diarrhea, and 10% of of suffering from a yeast infection. That’s potentially 300,000 complications. Furthermore, 0.24% of people will suffer a potentially life-threatening allergic reaction, and of these, about 1 out of every 10 will die (240 people). What’s worse, only about 1/3 of people with rheumatic fever will develop long-term heart disease. So you’ll have to treat 3 million people with antibiotics to prevent one case of heart disease. That means 900,000 people will suffer complications and about 720 people may die. Ten million antibiotics are prescribed in this country every year for throat infections.

Does this mean that we should shop prescribing antibiotics? Absolutely not. In selected situations, it would be inappropriate to withhold antibiotics. But in most cases, antibiotics are prescribed for a sore throat, viral infections, or a slight suspicion of a bacterial infection. In many instances, tonsils can become huge and obstruct your breathing, aggravating sleep apnea temporarily. Sometimes it can even lead to an abscess.

I still remember the one time I had Strep throat when I was a senior in high school. I was spiking fevers, sweating profusely, and was weak, dizzy and lightheaded. I was miserable. Despite this I played my bass clarinet solo in our annual symphonic band concert. After the performance, my father took me to the local ER, where they saw huge, inflamed tonsils. I was tested positive for Strep, and was given a penicillin shot. The next day, I felt 95% better. The point of this story is that we should try to avoid using antibiotics inappropriately, especially when there’s no absolute need.

Here’s a related short discussion on this topic.


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