I read the different opinions in the thread on overuse of antibiotics from our resident doctors and people in related fields, and I didn’t get a sense that there was a consensus - some said a healthy person will get better anyway and that the threat of rheumatic fever was slim, and some said you should get a rapid strep test anyway and go ahead and take the pills. Is there any consensus these days?
Adult docs will usually treat strep throat. It helps people get better faster (albeit by only a moderate amount) and it tremendously shortens the contagious period. (With treatment considered not contagious within 24 hrs, without it can be up to 2 weeks.)
Furthermore, the standard of care for strep throat is to treat it. As is noted by DSeid, it does protect others in the community from illness by treating it.
It’s still debatable whether or not treatment does shorten the course in any meaningful way.
I was most disappointed to hear that treatment may not prevent bad outcomes. 
It’d be kind of pointless not to give antibiotics, wouldn’t it? I mean, the reason to not give antibiotics all the time is so bacteria won’t develop resistance to them, but if we never used antibiotics at all, what would it matter if bacteria resisted them? Strep throat is bacterial, so antibiotics can do some good, so that’s one of the situations where you do want to use them.
I’m not advocating not treating in opposition to standard practice, but in terms of bacterial infections, strep throat in an immunocompetent patient is small fry. As noted above, save for a few cases (that may not be affected by antibiotic therapy anyway), strep throat is VERY unlikely to kill people or even cause a protracted course of debilitating illness. What we need to save antibiotics for are problems that commonly cause people to be very sick or die, such as sepsis, pneumonia, severe soft tissue infections, bacterial meningitis, etc.
That’s true to an extent. But we also want to keep patients who are at risk for complications from strep (the immunocompromised, the chronically ill) from getting exposed too often. That’s why we treat the cases we see; it reduces the pool of strep floating around.
Strep will always be endemic. Judicious antibiotic use can prevent it from being pandemic, which would cause permanent injury to many more people.
Thinking back to my youth, when I frequently got strep, I would think that sitting through it for 2 weeks :eek: would have been difficult, if not dangerous. I remember being unable to swallow even cold liquids. This was fine for the short time until the antibiotics kicked in, but I think 2 weeks without swallowing would be unrealistic at best.
It’s two weeks being contagious, without antibiotics.
The best evidence indicates that treatment with antibiotics reduces the time with symptoms minimally, if at all.
It’s a nearly universal opinion that acute strep throat should be treated. I posted a number of further opinions and links in the other thread.
Here’s the link I gave for the party line:
"Sample link for the pary line: http://www.aafp.org/afp/20010415/1557.pdf "
Within that link are guidelines for when to treat based on presentation (when a patient clearly meets all four clinical presentation criteria), when to do a confirmatory test for strep (when two or more criteria are met) and then treat based on the test results, and a general algorithm.
Treatment has been shown to diminish the duration of acute symptoms, diminish acute complications such as tonsillar abscess and diminish the incidence of post-streptococcal rheumatic fever.
Having said all of that (and I hope I presented the controversies well in the other thread), all of these things are muddied by softness of evidence, including especially the fact that many of the strongest studies for antibiotic use were in patients where an injectable long-acting penicillin was the agent used for treatment. This is relatively uncommon approach today, with broader-spectrum oral agents frequently being used. Also, prevalence of rheumatic fever varies over time and by population. Right now it’s relatively rare in the US and a relatively common problem among New Zealand Maoris exposed to strep, for instance.
If you glance through that thread you’ll see a number of links I posted around some of these controversies.
Having said all that, the bottom line is that yes, most doctors consider a strep throat to be a definite indication for antibiotic administration. Note that much of the controversy is when and how to decide it’s strep, for precisely the reason that strep is considered an indication for antibiotics while most other causes for sore throat are not considered a reason for antibiotic use.
Though antibiotics does keep it from rolling into a secondary infection that ends up as pneumonia in me [a very well known issue with me sigh]
I would love to be mrAru - he gets the sniffles, his throat will be sore for a day, then he is all better. On second though, he can get poison ivy from looking at the wiki entry so maybe not… 
[he just had it on one small part of his hand, 3 days later 80% of his body Prednisone time again]