Did you ever hear of not medicating a kid with strep?

the world's best mom

Wed, Mar 13 2013, 9:54 pm

@ md amother: I believe all or most of us know the difference between a viral URI and a bacterial infection. We know not to treat colds.

However, I have never heard of colonization of strep. Are you saying that strep can be viral or bacterial? Is colonization just viral? I don't understand.

My children are medicated for strep. I have a dd who gets spots on her face when she has strep. Then I know to take all of my kids to the doctor. My next dd sometimes complains of a stomach ache and ds coughs or has no symptoms.

If you say antibiotics aren't necessary or don't help, how can you explain this: The spots on dd's face will get worse and worse until she is on antibiotics. They start between her nose and mouth and then spread around her face. The sooner she starts medicine, the sooner they begin to disappear. However, she doesn't usually have fever, and her throat hardly gets red. So you think it's a virus? Then why do the antibiotics make the spots disappear?

I am not a doctor, but here's my take on the whole antibiotics issue: The doctor has to weigh the risks of medicating vs. the risks of not medicating. The risks of medicating include building up resistance to the drugs, and upset stomach. So I can hear waiting it out for a mild ear infection or a sinus infection with no complications.

However, if a child has strep, which is known to cause a lot of damage in certain cases when left untreated, I would think the risk of not treating it is greater. Same with a sinus infection that is causing wheezing- if a child cannot breath properly, that is more dangerous than a dose of antibiotics will ever be.

MommytoB

Wed, Mar 13 2013, 11:05 pm

There are great arguments on both side of this and there are certainly times when treating strep bacteria may not be neccesary depending on the circumstances.

The question was in absence of fever, did this doctor make the right call. That's hard for us to know...the child could be a carrier and have a cold (in which case the culture would be positive for strep bacteria as he is a carrier, but strep would not be causing an illness, the virus would). Doctor's know the signs.

In general, my doctor's guide is that fever is not important -- how a child is acting is a much better indicator. I've had kids with fever act totally fine and kids with no fever be very sick. Yes, with strep we have had positive tests with no fever, but given their other symptoms (lethargy, pain etc) antiobiotics were indicated. Paying attention to a child's mood is often a great indicator of illness.

amother

Thu, Mar 14 2013, 11:11 am

the world's best mom wrote:

MD amother here. Sounds like you're referring to strep erysipelas, which is a different manifestation of strep altogether and should definitely be treated with abx promptly.

Strep A is a bacteria. It is totally different than a virus. What colonization refers to is the phenomenon that your body is home to many forms of bacteria- in your mouth, in your throat, on your skin, in your GI tract. Theese co-exist with you and do not cause trouble generally and should not generally be treated. So if a kid with a viral URI, or a stomachache, or asthma, etc. goes to the doctor and the mom says, 'test my kid for strep!', the doc may do it just to make them happy, and the result may be positive, but that DOES NOT MEAN that the 'strep' needs to be treated, since they really need to be diagnosed with what's truly going on, like a viral URI, or given albuterol for their asthma, etc.

That's why we generally try not to do throat swabs in the first place for people who do not look like they have strep throat (based on the clinical criteria I posted above), since if they are positive (but not actually responsible for the clinical syndrome, be it a viral URI or asthma or a stomacheache) the patient will be like, 'you're not treating my strep! I will develop rheumatic fever like my great uncle so-and-so did in Europe! and you are a horrible doctor and I will post all about you on my message boards' etc. when really they do not need abx at all.

What you're describing sounds like a totally different type of strep infection, I.e. a skin infection, which, if seen by a competent physician, should be treated empirically with abx since often the wound cultures may not even grow out any strep at all, although usually a throat swab should show strep (but not always and abx should generally be given anyways to prevent the cellulitis from worsening).

Hope I clarified. Please discuss any and all medical questions with your own MD. Now if you'll excuse me, I'm going to get back to my patients.