Strep throat without antibiotics

Treating Strep Throat: Do You Really Need That Antibiotic?

Exposure to too many antibiotics can lead to antibiotic resistance, a problem that causes 23,000 deaths each year, according to the Centers for Disease Control and Prevention (CDC). Resistance is when bacterial growth can no longer be controlled or killed by an antibiotic.

“People should hope that their doctor does not prescribe an antibiotic,” says Aaron Glatt, MD, the chairman of medicine at South Nassau Communities Hospital in Hewlett, New York, and a spokesperson for the Infectious Disease Society of America. “They also shouldn’t expect a prescription every time they visit their doctor.”

Glatt says that people need to change the way they think about doctor visits. They should go to a doctor for a diagnosis and a recommendation on how to treat an illness, not to always walk away with a prescription in hand.

It’s also important to remember that antibiotics can have side effects, and patients may even have allergic reactions to them. Antibiotics can also be expensive, especially if you do not have insurance and have to pay with cash, says Dr. Glatt.

“It has to be the right person, the right time, and the right drug,” said Glatt.

“There’s a lot of overdiagnosis for strep throat that leads to overtreatment,” says Stanford Shulman, MD, one of the authors of the 2012 guidelines for strep throat diagnosis and treatment by the Infectious Diseases Society of America (IDSA).

Dr. Shulman, a doctor at the Ann and Robert H. Lurie Children’s Hospital and a professor at Northwestern University’s Feinberg School of Medicine in Chicago, says there’s some confusion over the diagnosis of group A strep throat. Often, a large number of people who are carriers of the bacteria don’t need to be treated. And a sore throat doesn’t automatically mean you have a strep infection.

A patient may come in with a sore throat along with cold symptoms, such as a cough, runny nose, pink eye, or a raspy or strained voice. With those symptoms, it’s more likely he or she has a viral infection, for which an antibiotic would be useless.

How to Know When Antibiotics Are Necessary

Strep throat is common in children because it’s easily spread through a sneeze, cough, or sharing food, among other ways. Watch out for these symptoms:

  • A fever
  • Sore throat that causes pain when swallowing
  • Swollen tonsils with pus
  • Absence of cough
  • Swollen lymph nodes

Some children may feel nauseated, have a headache or a stomachache, or vomit. A number of children with these symptoms may have scarlet fever, a fever accompanied by a rash.

Doctors have to be selective about testing for strep throat, says Shulman. Strep throat is not diagnosed just by symptoms: There are two tests used to confirm it. The doctor or medical professional takes a throat swab, called a rapid strep test, or a throat culture. If the test comes back positive for the bacteria, then the doctor will usually prescribe an antibiotic.

But strep throat is a self-limited disease that will go away on its own, says Shulman. Antibiotics are not prescribed to treat strep itself, but to prevent serious complications, such as rheumatic fever. Also, after the initial 24 hours of taking antibiotics, people can go back to work or school because they’re not considered contagious anymore, though their symptoms may take a little longer to subside.

“Patients should actually ask if they really need to take an antibiotic,” says Waldetoft. “Over here we are very concerned with antibiotic resistance and try to use narrow spectrum antibiotics whenever we can.”

Narrow spectrum antibiotics, which the authors of the review recommend for treating certain cases of strep throat, are limited in the number of bacteria targeted and will not affect as many of the normal bacteria in the body. The IDSA guidelines recommend narrow spectrum antibiotics such as penicillin. Penicillin is the treatment of choice, and strep bacteria hasn’t been found to be resistant to it. (Waldetoft shared that his research did find that penicillin isn’t effective in urinary tract infections because of bacterial resistance.) Amoxicillin is considered to be a broader spectrum antibiotic, so it will kill more bacteria than penicillin.

Right now, total elimination of antibiotics for treatment of strep throat is not an option, because there are no real replacements. But it is well worth considering alternatives, because there are other consequences of antibiotic overuse for people down the line, says Waldetoft.

In the meantime, we wait for government agencies and pharmaceutical companies to develop alternative therapeutics. The World Health Organization (WHO) has a number of programs that address antibiotic resistance. By 2023, it aims to develop new treatments through the enhancement of existing antibiotics and development of new antibiotic drugs.

If someone feels ill he or she should definitely consult a doctor. The important thing is not to expect or demand an antibiotic every time you get a sniffle — and never, ever, try to self-medicate with antibiotics.

“Antibiotics are wonderful when they are needed,” says Shulman. “We don’t want to overuse them.”

What You Need to Know About Strep Throat

Strep throat is a contagious infection caused by bacteria called Group A Streptococcus.

These bacteria can cause infections ranging from mild infections, such as cellulitis and impetigo, to more serious conditions, such as rheumatic fever, kidney problems, toxic shock syndrome, and necrotizing fasciitis. Strep throat and mild skin infections are the most common forms of illness caused by these bacteria.

Strep bacteria pass from one person to another when an infected person coughs, sneezes, or touches another person or object with a hand contaminated by infected droplets of fluid from the airways or throat. It takes two to seven days for symptoms to appear after someone has been exposed.

Range of symptoms

These are common symptoms of strep throat:

  • Sore throat and pain when swallowing

  • A red throat that’s swollen and may be dotted with white or yellow pus

  • Swollen neck glands (lymph nodes)

  • Low to high fever, depending on age, possibly with chills

  • Headache and body aches

  • Loss of appetite, nausea, and vomiting

  • In children, symptoms may also include abdominal pain, vomiting, and a red rash with small spots worse in skin creases and under the arms.

Symptoms often appear suddenly, without a cough or cold symptoms. In fact, a cough and congested nose make it very unlikely that a person has strep throat as opposed to a viral sore throat.

What to do

If you have symptoms of strep, see your health care provider for a diagnosis. If your provider suspects a strep infection, you will probably be given a rapid strep test, which involves taking a sample of throat secretions with a cotton swab. If the test is positive, it’s a strep infection. If the test is negative, the sample may be sent to a lab for a throat culture. This means trying to grow any bacteria in the sample to see if strep is present. This test usually takes 48 hours for results. Most throat infections are caused by viruses and do not need antibiotic treatment.

If the rapid strep test or the throat culture confirms strep, your health care provider will prescribe a course of penicillin or another antibiotic, which will make you better faster. Group A strep is the main bacteria to cause sore throat and the only type that needs antibiotic treatment. Within a day or so of beginning antibiotics, your symptoms should improve. You aren’t considered contagious after you have been on antibiotics for 24 hours, but you must complete the entire course of medication to help prevent complications such as rheumatic fever. Take all your medication even if you feel better within a few days.

Follow these steps to prevent spreading the bacteria and infecting people:

  • Don’t share utensils, dishes, drinking glasses, food, drinks, napkins, handkerchiefs, or towels.

  • Prevent the spread of fluid droplets from sneezing or coughing by covering your mouth and nose.

  • Wash hands frequently.

Strep infections that are left untreated or not treated completely can lead to rheumatic fever, an illness that can damage heart valves, and also may cause glomerulonephritis, a serious kidney disorder.

Easing symptoms

These steps can help you feel better, but they aren’t a replacement for antibiotics:

  • Take acetaminophen or ibuprofen as needed for fever and body aches. Do NOT give aspirin to children because it can cause a dangerous condition called Reye syndrome.

  • Gargle with saltwater.

  • Use throat lozenges or hard candy.

  • Eat soft foods.

  • Drink plenty of liquids.

  • Rest in bed.

  • Run a cool-mist humidifier to add moisture to the air.

  • Place a warm, moist towel around the throat.

The fever that accompanies strep usually stops one to two days after you start taking antibiotics. The sore throat passes soon after that.

Talk to your health care provider if you have questions about strep throat.

There is also a condition called Pediatric Autoimmune Neuropsychiatric Disorder associated with group A Streptococcus infection (PANDAS). This is a somewhat controversial condition linking group A strep infection in children with possible development and/or exacerbation of obsessive compulsive disorders or tic disorders (Tourette’s syndrome) in children.

Rheumatic fever

Acute rheumatic fever (ARF) is a serious complication of strep throat. It is thought that if the strep throat infection is untreated or inadequately treated by antibiotics, the bacteria remain in the tonsils and promote a persistent immune response from the body. Certain strains of the bacteria are more likely than others to cause this response. At times, this ongoing immune response may trigger the immune system to mistakenly attack other organs in the body including the joints (causing inflammation of the joints or arthritis) and the heart valves. The involvement of heart valves can cause damage of the heart valves and potential heart failure.

Treatment with appropriate antibiotics, even if started several days after the resolution of the infection, may prevent acute rheumatic fever. Fortunately, acute rheumatic fever it is now less common than in the pre-antibiotic era.

Kidney problems

A similar immune process to acute rheumatic fever may involve the kidneys and result in kidney inflammation called post-streptococcal glomerulonephritis (PSGN). There is unfortunately no evidence that treatment of strep throat will prevent this condition. Children under the age of seven are at the highest risk of developing PSGN after an episode of strep throat. This condition is more common but less ominous than rheumatic fever. It typically resolves spontaneously after a few, weeks and generally does not lead to permanent kidney damage.

Strep Throat Complications

Topic Overview

Complications of strep throat are rare but can occur, especially if strep throat is not properly treated with antibiotics. Complications can be related either to the strep infection or to the body’s immune response to the infection.

Complications related to the strep infection

Although rare, complications can result from the strep infection spreading to other areas of the body. Infection can spread to the:

  • Middle ear (otitis media).
  • Sinuses (sinusitis).

Other, more rare, complications include:

  • Infection behind the pharynx (retropharyngeal abscess).
  • Infection of the lymph nodes of the neck.
  • A peritonsillar abscess.
  • Toxic shock syndrome.

Complications related to the body’s immune response to strep bacteria

Sometimes in response to a strep infection, the body’s immune system will attack healthy tissues, causing complications such as rheumatic fever, inflammation of the kidneys (glomerulonephritis), or pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).

  • In rare cases, untreated strep may progress to rheumatic fever. Antibiotic therapy begun as late as 9 days after the start of a strep infection will prevent rheumatic fever.
  • Glomerulonephritis may occur after infection with certain strains of strep bacteria. These infections may include a strep infection of the skin (such as impetigo), usually during the summer months, or the throat (such as strep throat), usually during the winter months. The condition is relatively rare and goes away without treatment. But some complications may require treatment. Treatment of strep infection may not prevent inflammation of the kidneys.
  • PANDAS is a term used to describe what happens with some children who have symptoms of certain disorders that get worse following infections such as strep throat or scarlet fever. The disorders whose symptoms get worse include obsessive compulsive disorder (OCD) and tic disorders such as Tourette’s syndrome.

What is the best antibiotic to treat strep throat?

Medically reviewed by Drugs.com Last updated on Apr 10, 2019.

Official Answer

by Drugs.com

Penicillin, or drugs from the penicillin-type class, such as amoxicillin, are usually first-line choices for strep throat. Cephalosporin antibiotics such as cephalexin may also be used.

If you have a severe allergy to penicillin-type drugs, a macrolide antibiotic such as azithromycin or clarithromycin might be used. Clindamycin is another option.

Most of these antibiotics come in a liquid form that will be easier for children to take.

The best antibiotic for a strep throat will depend on many patient-specific factors, such as allergies, tolerance to medications, ability to swallow tablets, resistance patterns, and cost concerns.

Related Drug Information

  • Amoxicillin Drug Information
  • Azithromycin Drug Information
  • Cephalexin Drug Information
  • Clarithromycin Drug Information

Other Medical Questions

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  • Are there any foods I should avoid while taking amoxicillin?
  • Can you take antibiotics while pregnant?
  • What antibiotics are used to treat pneumonia?
  • Does amoxicillin expire? Is it safe to take after expiration?
  • What’s the difference between amoxicillin and penicillin?

You have been taking antibiotics for a sore throat, but after two days you feel better – except that the tablets make you feel sick. So must you keep taking them? Traditional wisdom is that failing to finish the course allows some bacteria to survive. These will be the hardier ones that can resist the same antibiotic should they meet it again. So for your own good, and that of antibiotic resistance worldwide, you should keep taking the tablets.

But last week, in an article in the Medical Journal of Australia, Professor Gwendolyn Gilbert of the University of Sydney wrote: “There is a common misconception that resistance will emerge if a prescribed antibiotic course is not completed.” She argued that there was minimal risk in stopping antibiotics if the signs and symptoms of a mild infection had resolved.

Professor Chris Del Mar, professor of public health at Bond University in Queensland, agreed, saying that, for most acute chest and urine infections, GPs should tell patients to stop taking the tablets once they feel better. Only for some conditions, such as tuberculosis or osteomyelitis, and other deep-seated infections where symptoms could improve even though the bacteria might still be flourishing, should patients continue taking antibiotics until they have finished the course or their doctor tells them otherwise. People who have problems with their immune system should also stick to the doctor’s advice.

But should most of us go against decades of medical advice and stop taking antibiotics once we feel better?

The solution

It’s complicated. It depends what you have been given antibiotics for. Gilbert says that stopping them prematurely will not directly increase the risk of resistance – that more commonly happens with prolonged treatment on suboptimal doses. In many cases, she says, our bodies can mop up any leftover bacteria. And as many people with respiratory tract infections don’t need antibiotics in the first place, because the infection is not actually caused by bacteria, stopping them is perfectly safe.

Antibiotics change the normal gut flora very quickly – wiping out the indigenous, harmless bacteria and leaving the patient susceptible to resistant bacteria such as Clostridium difficile. “So for individual patients,” says Gilbert, “the less antibiotic they are exposed to, the better.”

Doctors vary in the length of antibiotic regimes they prescribe, with five-day courses for urinary tract infection still being used even though the evidence shows that two to three days is sufficient for an uncomplicated infection.

So if you are given an antibiotic, first ask your doctor if you really need it, and then if you can stop taking it when you feel better. It is too complicated a question (depending, as it does, on the infection and your medical history) to answer with a simple yes.

Home Remedies for Strep Throat Symptoms

The scratchy, burning pain of a sore throat can make life miserable. From sipping water to answering the phone, everyday tasks are suddenly painful challenges.

While it’s common to think you may have strep throat, the bacterial infection can only be diagnosed by a throat swab test.

If you test positive for strep, it’s important to take any prescribed medications, including antibiotics, as not doing so can lead to serious health complications such as rheumatic fever or heart murmurs.

It usually takes only a day or two after starting antibiotics to feel better, but in the meantime, there are some things you can do to help ease the symptoms, including some quick and easy home remedies for strep throat.

What Causes Strep Throat

Strep throat, also known as streptococcal pharyngitis, is caused by bacteria called group Astreptococcus, or Streptococcus pyogenes, which can seed the nose and throat.

You can get the infection from someone who is sick with strep, as it spreads through close contact with saliva.

Symptoms, which include fever, sore throat, red tonsils, and enlarged lymph nodes in the neck, typically begin one to three days after exposure and last seven to 10 days.

How to Test for Strep Throat at Home

The only way to know definitively if you have strep throat is through a rapid strep test administered by your doctor or at your nearest GoHealth Urgent Care. And while home strep tests are available, they aren’t 100 percent accurate and can produce false negative results.

You can examine your throat for signs of infection by looking in the mirror and saying, “Ahhh.” If you see white dots or patches in the back of your throat, or your tonsils are red and swollen, you may have strep throat and should see your doctor or go to your local GoHealth Urgent Care.

Home Remedies for Strep Throat

Sore throat is not the same as strep throat, as strep is a bacterial infection, yet many sore throat remedies can also help ease the symptoms of strep throat.

In addition to getting plenty of rest and drinking lots of water, you can try the following home remedies, which are aimed at killing the bacteria that causes strep throat. Keep in mind, however, the only way to cure strep throat is with antibiotics.

Supplements

  • Elderberry has antibacterial and antiviral effects and has shown to protect against the risk of upper respiratory disorders and virus- and bacteria-induced respiratory infections on flights. Elderberry is available as a tea, and in capsule, powder, or liquid form.
  • Echinacea is best known for its ability to prevent the common cold, but research suggests it may also stop the spread of bacterial conditions like strep throat. Echinacea’s anti-inflammatory properties can also help relieve pain related to strep throat. Take echinacea in liquid form, as a tea, or in capsule form as soon as symptoms appear.
  • Vitamin C can boost your immune system as well as kill infections already in your body. If you have strep throat, boost your vitamin C consumption by taking a supplement and eating foods rich in vitamin C like oranges, kale, strawberries, grapefruit, and kiwi.
  • Vitamin D deficiency has been linked to respiratory infections, and research has shown it plays an important role in the immune system.

Foods

  • Raw honey raises antioxidant levels in the body, which helps boost the immune system, and its consistency has long been used to ease sore throats. Studies have found that medical-grade honey can fight some of the bacteria that cause infections.
  • Bone broth can keep you hydrated when a sore throat makes it difficult to swallow other foods. It also provides minerals that boost the immune system and help reduce swelling and pain. Drinking warm bone broth made from protein powder throughout the day can help ease the symptoms of strep throat.
  • Herbal tea for strep throat can help ease pain and treat inflammation. Chamomile tea has antioxidants that help reduce pain, congestion, swelling, and redness, while dandelion tea may help fight infection while boosting your immune system.
  • Apple cider vinegar has powerful healing compounds such as acetic acid, which can kill harmful bacteria while promoting the growth of beneficial bacteria.
  • Warm comforting drinks also help soothe symptoms while being gentle on sore throats.

Essential Oils

  • Peppermint oil can reduce swelling in the throat, while its naturally occurring menthol provides a cooling and calming sensation. Mix 1 to 2 drops of peppermint oil in a glass of water and drink it or apply 1 to 2 drops to the skin around your throat, chest, and temples.
  • Lemon oil has antibacterial properties and has been shown to limit the growth of antibiotic-resistant bacterial strains. Add 1 to 2 drops to a glass of water or herbal tea.
  • Thyme oil is a common home remedy for strep throat symptoms. Research has shown it’s effective in killing bacteria taken from patients with oral and respiratory infections. Add 1 to 2 drops of thyme oil to a glass of water and gargle or add thyme oil to your bath for relief of body aches.

Other Things to Try

  • Gargling with Himalayan salt can soothe a sore throat, reduce painful swelling, and kill bacteria present in your mouth. The salt’s antibacterial properties are also known to improve respiratory conditions. Mix 1/4 teaspoon (1.42 grams) of table salt in 8 ounces (237 milliliters) of warm water. Be sure to spit out the liquid after gargling.
  • Oil pulling has been shown to reduce the presence of strep bacteria and other toxin in the mouth. Swish 1 to 2 tablespoons of coconut oil in your mouth for at least 10 minutes, then spit it out, rinse your mouth, and brush your teeth.

Will Strep Throat Go Away on Its Own?

Strep throat typically goes away in three to seven days with or without antibiotic treatment. However, if you don’t take antibiotics, you can remain contagious for two to three weeks and are at a higher risk for complications, such as rheumatic fever.

What’s more, complications resulting from the bacterial infection can lead to increased susceptibility to other viral infections like influenza which can be fatal.

If you have been diagnosed with strep throat, you can help prevent repeat infections by changing your and your families’ toothbrushes and thoroughly disinfecting all surfaces that may have been in contact with the strep virus.

If these at-home remedies don’t help alleviate your sore throat symptoms after 48 hours, you can book an appointment online with us; the widget below will help you find the GoHealth Urgent Care center nearest you.

See our prices on co-pays and same-day visits, with and without insurance.

GoHealth Urgent Care partners with these regional healthcare providers:

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