Any Pediatricians here - antibiotics for strep if symptoms are gone?

[Anonymous]

My inclination would be to not start abx in child who is feeling better who has not yet started the course. Sounds like you rightly know to finish abx in the child who already started.

My ped has always been very conservative about giving antibiotics as strep often resolves on its own.

I would like to hear more about the heart issues, though. I could be persuaded if there's enough scientific research.

[Anonymous]

Anonymous wrote:My inclination would be to not start abx in child who is feeling better who has not yet started the course. Sounds like you rightly know to finish abx in the child who already started.

My ped has always been very conservative about giving antibiotics as strep often resolves on its own.

I would like to hear more about the heart issues, though. I could be persuaded if there's enough scientific research.

The scientific evidence that strep can lead to rheumatic fever, which can cause heart damage, is overwhelming and has been well known for at least a century.

[Anonymous]

My kid is on prophylactic antibiotics until at least puberty for strep, due to pandas like reaction and increased titters. It has been a long process to get and keep him well.

For the posters who are wary about antibiotics: I once was you. As a result, DS got very sick and spent a night in children's and had countless Drs appointments. I regret not being on top of all the times we had strep tests that were negative . Symptoms were loss of appetite. That's it. Looking back he probably had strep for 5 months before the OCD symptoms began and his immune system started attacking his body.

Even now the stains of strep can break through the antibiotics.

Antibiotics are not the issue. Strep is getting more virulent.

[Anonymous]

Of course step goods away on its own. Antibiotics are a relatively new thing.

[Anonymous]

Some really really bad advice on this thread.

I'm a pediatrician. Here are some facts.

Active strep infection will nearly always go away on its own (as long as the host has a normal immune system) in just a few days. The point of antibiotics (with strep) is not really to eliminate the infection itself.

The biggest issue with strep infections is that the antibodies we produce to eliminate it have a nasty habit of cross-reacting with some of our own body proteins and leading to autoimmune diseases. The biggest worry is for rheumatic heart disease (which can destroy heart valves) and post-streptococcal glomerulonephritis (which can lead to kidney failure). Other problems from strep antibodies include arthritis and many other issues.

The point of antibiotics with strep is to limit our body's response to decrease the risk for these post-strep autoimmune problems. The scientific evidence supporting aggressive antibiotic treatment for strep is overwhelming.

It is generally a very good idea to limit antibiotic usage and it is certainly true that we use too many antibiotics in general. This is not true when it comes to strep. Always (ALWAYS) complete the whole course of antibiotics for strep.

People who don't know what they are talking about need to stop dispensing medical advice on the internet. It is dangerous.

[Anonymous]

Anonymous wrote:Some really really bad advice on this thread.

I'm a pediatrician. Here are some facts.

Active strep infection will nearly always go away on its own (as long as the host has a normal immune system) in just a few days. The point of antibiotics (with strep) is not really to eliminate the infection itself.

The biggest issue with strep infections is that the antibodies we produce to eliminate it have a nasty habit of cross-reacting with some of our own body proteins and leading to autoimmune diseases. The biggest worry is for rheumatic heart disease (which can destroy heart valves) and post-streptococcal glomerulonephritis (which can lead to kidney failure). Other problems from strep antibodies include arthritis and many other issues.

The point of antibiotics with strep is to limit our body's response to decrease the risk for these post-strep autoimmune problems. The scientific evidence supporting aggressive antibiotic treatment for strep is overwhelming.

It is generally a very good idea to limit antibiotic usage and it is certainly true that we use too many antibiotics in general. This is not true when it comes to strep. Always (ALWAYS) complete the whole course of antibiotics for strep.

People who don't know what they are talking about need to stop dispensing medical advice on the internet. It is dangerous.

THANK YOU.

PP who is a "retail pharmacist" -- please don't comment on threads dispensing medical advice. You are not a doctor!

[Anonymous]

Anonymous wrote:Some really really bad advice on this thread.

I'm a pediatrician. Here are some facts.

Active strep infection will nearly always go away on its own (as long as the host has a normal immune system) in just a few days. The point of antibiotics (with strep) is not really to eliminate the infection itself.

The biggest issue with strep infections is that the antibodies we produce to eliminate it have a nasty habit of cross-reacting with some of our own body proteins and leading to autoimmune diseases. The biggest worry is for rheumatic heart disease (which can destroy heart valves) and post-streptococcal glomerulonephritis (which can lead to kidney failure). Other problems from strep antibodies include arthritis and many other issues.

The point of antibiotics with strep is to limit our body's response to decrease the risk for these post-strep autoimmune problems. The scientific evidence supporting aggressive antibiotic treatment for strep is overwhelming.

It is generally a very good idea to limit antibiotic usage and it is certainly true that we use too many antibiotics in general. This is not true when it comes to strep. Always (ALWAYS) complete the whole course of antibiotics for strep.

People who don't know what they are talking about need to stop dispensing medical advice on the internet. It is dangerous.

Op here. Thank you very much for this response. We had decided to go forward with the abx even without talking to the Dr, and this confirms that decision as the child in question actually already has another autoimmune disorder. However I will be trying to switch the prescription from Penicillin to Amoxicillin today as the fight to actually get the penicillin ingested just doesn't seem at all worth the perhaps slight increase in efficacy, an issue I think pediatricians offices may understand better than the Minute Clinic. And this description of *why* to take antibiotics for an asymptomatic infection is exactly what I'd been hoping to get from a conversation with the Dr which hasn't happened yet - will try to call again this morning.

On another note - I'm wondering if I should bring up our issues with the on-call system next time I speak with the Dr. In my mind this seems like the perfect question to ask an on-call Dr, i.e. "Should I start my non-symptomatic child on antibiotics" - obviously not a critical issue requiring the ER, but not something I necessarily want to wait a day or 2 to start either. So I'm a little frustrated that I wasn't actually able to speak to the Dr yesterday. Did eventually get a call from the triage PA, but to be honest I wasn't impressed with her ability to follow the details of our situation or understand that the heart of this question is a scientific risk analysis.

So a question for the pediatrician if you check in - am I correct that this type of time-sensitive but not life threatening issue IS the time to call the on-call / after hours doctor? And I'll note my original call to the Dr was at 4:30PM, though I didn't actually get a call back from anyone until 9PM after I called a second time at 8:30PM. So it's possible the real issue was the answering service vs. the medical staff.

[Anonymous]

Anonymous wrote:Some really really bad advice on this thread.

I'm a pediatrician. Here are some facts.

Active strep infection will nearly always go away on its own (as long as the host has a normal immune system) in just a few days. The point of antibiotics (with strep) is not really to eliminate the infection itself.

The biggest issue with strep infections is that the antibodies we produce to eliminate it have a nasty habit of cross-reacting with some of our own body proteins and leading to autoimmune diseases. The biggest worry is for rheumatic heart disease (which can destroy heart valves) and post-streptococcal glomerulonephritis (which can lead to kidney failure). Other problems from strep antibodies include arthritis and many other issues.

The point of antibiotics with strep is to limit our body's response to decrease the risk for these post-strep autoimmune problems. The scientific evidence supporting aggressive antibiotic treatment for strep is overwhelming.

It is generally a very good idea to limit antibiotic usage and it is certainly true that we use too many antibiotics in general. This is not true when it comes to strep. Always (ALWAYS) complete the whole course of antibiotics for strep.


Thank you for this information! Very clear, and not something most of us are aware of.

People who don't know what they are talking about need to stop dispensing medical advice on the internet. It is dangerous.

[Anonymous]

Also be sure to toss old toothbrushes and get new after every strep incident.