Thursday, March 21, 2013
Does a sore throat mean that you need a course of antibiotics?

By Dr. Anthony Policastro
A common complaint by patients is sore throat. Frequently patients think that a sore throat is a reason to get antibiotics. As is often the case, it is more complicated than that. Strep throat is a common childhood condition. It causes a bacterial throat infection. We treat it with antibiotics. However, it is not the most common cause of sore throat. Therefore, treating everyone with a sore throat with antibiotics is a bad idea. It would mean that people would have the inconvenience of taking medication they do not need. It would mean that they might have side effects from the antibiotic. It might increase the chances of antibiotic resistant bacteria developing. Some people think that antibiotics are necessary to treat strep throat. That is not true. Most patients will get better in about 72 hours. We do not treat strep throat to make it better. We treat it to prevent rheumatic fever. Rheumatic fever is a complication of untreated strep throat in children. It involves the heart, the joints and the skin. It may involve the brain. For that reason, we treat strep throats with antibiotics. In addition, the symptoms of strep throat will get better in about 24 hours. However, the antibiotics will need to be taken for the full 10 days to prevent rheumatic fever. Strep infections are always sensitive to penicillin. However, they sometimes come back. For that reason more than one course of antibiotics might be necessary. Strep throat is not the most common cause of sore throat. Most sore throats are due to viruses. Antibiotics will not help them. Therefore, the doctor will often do a rapid strep test to help determine what is causing the infection. A positive test means it is definitely strep. That means an antibiotic is needed. A negative test means that it is likely to be a viral infection. However, some people with strep throat will have a negative rapid strep. They would need a real throat culture to tell if they truly have strep or not. So you can have strep with a negative rapid strep. It is just unlikely to be the case. There are many viruses that cause sore throat. Some of them will actually cause blisters or canker sores in the throat. When you see this on exam, you know it is viral. It is also very painful. Therefore, people think it must be strep for that reason. That is not the case. Usually, the virus that causes this is related to the one that also causes cold sores. The Ebstein-Barr virus causes infectious mononucleosis (mono). This is frequently associated with a severe sore throat. Of interest is the fact that sometimes amoxicillin is prescribed. This is when the thought is that it might be strep. Patients with mono on amoxicillin will almost always develop a rash. That sometimes helps to make the diagnosis. Laryngitis causes pain in the voice box. It is associated with hoarseness. It is associated with cough. Given its location, people will often complain that they have a sore throat. However, it is in a much lower location. Thus, cough usually means that it is not a strep throat. Postnasal drip can irritate the back of the throat. However, that is unusual. It is rarely a significant cause of sore throat. There are many other causes of sore throat. Most of them are relatively rare. Patients will often call the physician with the complaint of sore throat. They will then say that they want an antibiotic called in. They think they know what they have. What they do not have is a medical degree. If they want an antibiotic for their sore throat, they have two choices. One is to see the physician to make sure it is indeed something that needs an antibiotic. The other is to go to medical school so they can write their own prescription. Sore throat is a symptom. It is not a diagnosis. Strep is only one of the many causes.

Asthma Awareness Day is May 11 The American Lung Association in Delaware, Bayhealth Medical Center, and Nemours Health and Prevention Services will host a carnival-themed asthma awareness day, "Asthma Under the Big Top," on Saturday, May 11, from 10 a.m. to 1 p.m., in Pavilions I & II at Bayhealth Kent General Hospital in Dover. Snacks and beverages will be provided. Families, children and caregivers are encouraged to attend this free event. To register or for more information, contact Nicole Goldsboro at 302-737-6414, ext. 16 or

Blood Bank offers screening program Not only are lives of patients on Delmarva saved when people give blood, but the blood donors themselves could be on the receiving end of important health news that could save their lives. In 2007, Blood Bank of Delmarva launched its innovative diabetes screening program for all donors. The Blood Bank tests the glucose levels of blood donors who choose to have the screening. In five years of testing, 269,315 donors were screened and 13,679 (as of Oct. 1, 2012) had elevated levels and were encouraged to see their personal physicians. For more information about the Blood Bank or to request an appointment to give blood, visit or call 1-888-8-BLOOD-8.

La Red Health Center recognized La Red Health Center (LRHC), has been recognized by the National Committee for Quality Assurance (NCQA), as a Patient Centered Medical Home (PCMH). A PCMH is a model of care where patients have a direct relationship with a provider who coordinates a cooperative team of healthcare professionals, takes collective responsibility for the care provided to the patient and arranges for appropriate care with other qualified providers as needed. Designed to improve primary care through a set of standards that describe clear and specific criteria, a PCMH organizes care around patients, and tracks an individual's care over time. Started by a network of physicians in 2001 to meet the needs of a growing number of locally uninsured individuals, LRHC is now a federally qualified health center whose mission is to be a center of excellence which provides quality patient centered care to the diverse members of our community. La Red Health Center has two convenient locations, one in Georgetown and one in Seaford. For more information, visit

Free colorectal screenings To mark National Colorectal Cancer Awareness Month in March, Bayhealth will offer free colorectal cancer screenings on the following dates, times and locations: Tuesday, March 26 at 5 p.m. at the Cancer Center, Milford Memorial Thursday, March 28 at 5 p.m. at the Cancer Center, Kent General Colon cancer is the third leading cause of death for men and women. The American Cancer Society recommends all men and women be screened for colorectal cancer beginning at age 50. Those at high risk for the disease, including African-Americans or those with a family history of colorectal cancer, should be screened at an earlier age. The screening will consist of a digital rectal exam (DRE) along with a fecal occult blood test (FOBT) to check for hidden blood in your stool. To register for a free screening, call Jennifer Nack at 302-430-5324 at least two weeks before the screening date.

Ethics conference at PRMC When New York Mayor Michael Bloomberg announced a ban on super-sized sodas sales, his decision created a media uproar. Advocates of individual liberty invoked fears of a "nanny state" where government officials would invade personal freedoms. Bloomberg's defenders pointed to the epidemic of obesity and the long tradition of governmental responsibility for public health. Add into this mix the impact of the new Patient Protection and Affordable Care Act and you have the ingredients for this year's Peninsula Regional Medical Center Patient Care Advisory Committee's eighth annual ethics conference. The conference topic is "Health Care Reform: Nanny State or Responsible Stewardship?" and will be held on Thursday, April 4, from 5 to 9 p.m. in the Hallowell Conference Center at Peninsula Regional Medical Center in Salisbury. Cost to attend the conference is $50 for physicians, healthcare professionals and the general public, $40 for PRMC and Salisbury University employees and $20 for full-time students and chaplains/clergy. A dinner will be provided. Registration is required by Thursday, March 28. For information or to register, visit, call Debora Musser of the Peninsula Regional Medical Center Pastoral Care office at 410-543-7157, or email

Community Health Promotion awards The Governor's Council on Health Promotion & Disease Prevention announces a call for submissions for Recognition of Community Health Promotion. The goal is to recognize the efforts of municipalities that are championing the health and well being of their local residents. Recipients will be communities that have demonstrated effective planning and implementation of best practice and/or creative and visionary programs to improve physical activity, nutrition/healthy eating, tobacco-free lifestyles, healthy environments; promote healthy lifestyles and integration of the needs of individuals with limited mobility and disabilities. All applicants must represent an incorporated municipality located within the State of Delaware and must focus on policy and practice changes related to improving the overall health of its respective community members. For more information and an application, contact Dr. Milton Delgado at or 302-444-9142. The deadline to submit an application is April 12. Upon submission, all applications will be reviewed by a subcommittee of the Governor's Council on Health Promotion & Disease Prevention.

Alzheimer's Caregiver Support Group Cadia Rehab Renaissance near Millsboro is hosting and facilitating an Alzheimer's Association Caregiver Support Group that meets the fourth Tuesday of each month at 6 p.m. All meetings are open to the public and interested parties are invited to attend. Alzheimer's disease is the sixth leading cause of death in the United States. One person out of eight who reaches the age of 65 will develop Alzheimer's, as will one person out of every two who reaches the age of 85.

2013 Walk MS dates The Delaware Chapter of the National Multiple Sclerosis Society has announced the 2013 Walk MS dates and is inviting all Delawareans to join the movement. Each year thousands of loved ones, friends, and neighbors throughout Delaware – from Wilmington's Riverfront to Sussex County's Baywood Greens – lace up and step out in solidarity, with hopes of creating a world free of MS. Last year, over a quarter million dollars was raised to help out the 1,550 Delawareans living with multiple sclerosis. The Twilight at Heritage Shores walk in Bridgeville will be held on May 31 and the walk at Baywood Greens will be held on June 7. To register, visit or call 302-655-5610.

CPR classes offered Nanticoke Memorial Hospital will offer community CPR classes to anyone interested in learning CPR at the Nanticoke Training Center located on Water Street in Seaford. Participants will learn how to perform the basic skills of CPR on adults, children, and infants and how to help an adult, child, or infant who is choking and use of the AED. This classroom-based, video, and instructor-led CPR course offers families, friends, and community members the opportunity to learn CPR and receive a course completion card. Classes are open to participants ages 12 and up. The target audience is those who have a duty to respond to a cardiac emergency because of job responsibilities or regulatory requirements. Cost is $45. Payment and registration is required by no later than five business days prior to the class. Late registrations may be accepted if seating is available. To register and obtain a listing of class dates/times, contact the Nanticoke Memorial Hospital's Training Center office at 629-6611, ext. 8919. Pre-registration is required.