Strep throat long treatment delay: what to do now?

I know that lots of you are not doctors or medical professionals, though some of you are. I could use some advice, professional and not.

I went to the doctor three weeks ago today sick with typical cold symptoms: sore throat, cough, nose swollen just about shut and very congested. No fever at all that I’d noticed, but the nurse practitioner (the only person I could get in to see) commented that my lymph nodes were a little swollen. She did a rapid strep test: negative. She mentioned that they would also do a throat culture. I agreed - never had strep as an adult, but just in case. She prescribed Augmentin, which I had filled and took for the full 10 days, every dose.

Fast forward three weeks to today. Around noon, I get a call from the doctor’s office that the longer-term throat culture grew bacteria, and they wanted to put me on Flagyl starting today. (I’m guessing because untreated strep can come with some nasty side effects, rheumatic fever and glomuleronephritis (or whatever that is) being most prominent). Flagyl’s list of side effects is long and quite nasty. I am not enthusiastic about taking it for other reasons also.

My questions:

  1. How much benefit, if any, would there be to taking Flagyl at this point? I read that antibiotic treatment is effective for preventing rheumatic fever if taken within 9 days of the onset of infection, and I did have Augmentin.

  2. Is the prescription just a cover-your-butt maneuver since they seem to have left my test results sitting on someone’s desk for an additional 19 days?

My advice is to call the prescribing doctor and ask these questions.

Well the real question is, how do you feel?

Typical cold symptoms do not warrrant a strep test. Augementin prescribed? For what?

A positive strep culture or rapid test in the presence of symptoms inconsistent with strep throat likely representsa carrier state, not strep throat, and does not need treatment.

Augmentin would more than treat a strep infection. Flagyl for strep? huh? Amox is almost always enough with rare exceptions and those exceptions are covered by Augmentin fine.

In kids at least 1 in 10 healthy kids will be carrying strep at any time; test them for no good reason and 1 in 10 of those tested will likely be treated for no good reason. Adding to antibiotic resistance and a host of other problems.

Accepting the story as told at face value you should never have been tested for strep, never cultured as well, never treated with Augmentin, and never told to go on Flagyl after treatment with Augmentin. I do not say this very often but if all occured exactly as you’ve said I’d look for better healthcare providers than what you’ve got.

You really need to talk to a doctor. It’s possible that a person occasionally becomes a persistent healthy carrier, though, and does need treatment despite being asymptomatic. If a couple people in a family get repeated infections, a doctor might test all the members, and discover that one asymptomatic person is positive, treat that person, and the infections stop. This happened in my family; I have no idea how rare it is, though.

There are also antibiotic resistant strains of strep. My husband got one, and took penicillin for 21 days, and appeared to get better, but got sick again, and progressed to what is known as “walking pneumonia” before taking augmentin for 14 days, along with something else for the first 3 days, and some other stuff to treat the symptoms.

Do you still have symptoms, or are other people you live with sick?

Or maybe you don’t have strep A, the thing usually responsible for strep throat-- maybe you have one of the other streps-- IIRC, there are 4 classes. Or do you work with a vulnerable group of people?

Talk to the doctor.

Thanks for the advice. The only symptom I still have in any degree is a slightly raspy voice, an improvement on the severe laryngitis I had 3 weeks ago.

My 14 y o daughter just came down with a cold last Wednesday. My husband did about a week after I did, went to a different doc, & also got Augmentin. He’s fine now.

I’ll certainly try for a call. The doc doesn’t speak directly to patients on the phone (or never has to me, anyway) but the nurse might.

FYI, to my knowledge neither of my kids has ever had strep, and my husband hasn’t gotten that diagnosis either AFAIK. All very odd.

Strep induced rheumatic fever is incredibly rare these days. The active strains of strep are much less likely to cause the antibody formation that attacks heart valve cartilage.

Treatment of strep does not affect rates of post-strep glomerulonephritis.

Don’t take Flagyl. What probably happened is your culture grew something that is probably a contaminate and the sensitivity report said it was susceptible to Flagyl so someone was instructed to call you to start it. No reason it should take 3 weeks for strep culture to turn positive.

My sister got strep-induced rheumatic fever last year. She’s early 30s and healthy, but was living in remote Central Australia, where strep is rampant and of the strains mostly likely to cause rheumatic fever. She had some damage to her heart, and was instructed to move away from the region ASAP.

So, not rare everywhere.

Good to know, I was only aware of US infection patterns.

Rare but not unheard of. It is still one of the main reasons to treat strep throat. After all strep throat symptoms will resolve without treatment in a few days anyway. We treat to speed recovery up marginally, to reduce the period of contagion, and to reduce that small but non zero risk of serious complications.

Grrlbrarian, please read this and consider sharing it with your healthcare providers. This one too.

As a profession we apparently really suck at being good antibiotic stewards.

Thanks for the articles, DSeid. I did read them and will definitely reference them, if not bring a copy, the next time I’m seen at the doctor for symptoms of this type.

USCDiver, I appreciate your advice about the Flagyl too, especially in context with the idea that there may have been issues with the culture.

And honestly, thanks, everyone! It’s good to hear multiple perspectives on the issue. After consideration, and given the lack of current symptoms, I decided against the medication.