From: ((Steven B. Harris))
Subject: Re: Holism, suppression, and isolation
Date: 27 Apr 1995
Newsgroups: misc.health.alternative

In <0031E36B.fc@pop.com> p_iannone@pop.com (Paul Iannone) writes:

>Alternative healing does not leave infections untreated. There are
many, many cases where antibiotic herbals are equally as effective
without being as damaging.<<

   "Many, many cases?"  Would you mind giving some details?

 >>Strep throat is a very bad, if constant, example. How is 'strep
throat' treated conventionally? Rather, is there a throat culture done
before any antibiotic is given? NO, NO, NO. They hand out the
antibiotics for any acute throat all day long.<<

    How long since you've been in a modern doctor's office complaining
of possible strep throat?  Not only is there a rapid strep enzyme assay
which makes many diagnoses within 5 minutes, but even if that test is
negative, many doctors only give enough empiric antibiotics (2 days
worth) until the culture results are in.  Many others give NO
antibiotics until culture results are in, knowing that the main value of
antibiotics with strep throat is not in clearing up the throat, but in
preventing heart and kidney damage (which can be done even if
antibiotics are withheld pending culture).  Doctors who simply prescribe
a full antibiotic course with no tests done, are a minority.

  >> So this is an example of an area of practice that receives
consistent malpractice by conventional therapy.<<

   The problem here is that you seem to have no clue as to what
"conventional therapy" is, in this example.  How then are you equipped
to make accusations about malpractice, through use of it?

>: So in my mind (and in my opinion, just an opinion mind
>: you) the truly holistic treatment would be to give the antibiotic
>: AND educate the person on good hygiene, healthy nutrition and
>: exercise.

   Gosh, yes. You should stretch a 15 minute office visit into an hour
that way, and maybe charge accordingly.  Hmmm.  Of course, it wouldn't
be long before the insurance companies and Medicare would have your
head.  If you worked for an HMO, it wouldn't be long before you got
fired.  And meanwhile your waiting room full of patients would not be
happy with you either.  All assuming you really had a good defense for
the idea that exercise (say) has anything at all to do with strep
throat.

 >Such is the relatively simplistic understanding of 'the whole person'
in conventional therapy.<<

   Simplistic understanding beats no understanding.  A holistic auto
mechanic would be cleaning your ashtrays in the process of repairing a
busted headlight.  There are LOTS of things that go wrong with the body
that are fairly mechanical, and you do a diservice to everybody trying
to relate them to the "whole person."

                                                  Steve Harris, M.D.

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: do I have antibiotic resistant infection?
Date: Mon, 18 Mar 2002 14:24:01 -0700
Message-ID: <a75m49$a95$1@nntp9.atl.mindspring.net>

"CBI" <00doc@mindspring.com> wrote in message
news:a73lvs$ejp$1@slb6.atl.mindspring.net...
> You should also consider that the real reason to aggresively diagnose
> strep and treat it is to prevent rheumatic fever/heart disease, a
> relatively rare occurence in this day and age. The vast majority of
> strep throats will get better on their own with no antibiotics.


In fact, there's some evidence they get better no faster with, than without.

Rheumatic heart disease is "rare" only if you don't work at a tertiary
referral center <g>. It's still out there. In any case, it's a problem for
kids, not adults. And at least, you can use a cheap antibiotic like Amoxil
to prevent it.

SBH

From: David Rind <drind@caregroup.harvard.edu>
Newsgroups: sci.med
Subject: Re: How Can I Cure Recurring Strep Throat?
Date: Tue, 09 Dec 2003 23:18:27 -0500
Message-ID: <br66mr$jmk$1@reader2.panix.com>

Lori wrote:
> I have had recurring strep throat for the past six weeks.  I was
> treated with Augmentin for 10 days after the first diagnosis; Omnicef
> for 10 days after the second diagnosis; and Omnicef for 14 days after
> the third diagnosis.  The first case was diagnosed with a quick test;
> the second two with cultures.  (By the time the culture results came
> back, I was into full-blown symptoms again.)
>
> Why aren't the antibiotics taking care of the infection and what can I
> do?

Although treatment failures are possible, it's worth making sure
that no one else you are exposed to is a carrier. People can have
strep and be reinfecting you even though they have no symptoms.

--
David Rind
drind@caregroup.harvard.edu

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med
Subject: Re: Scarlet Fever?+Amoxicillin=Hives?
Date: 3 Apr 2005 15:04:36 -0700
Message-ID: <1112565876.438494.266640@f14g2000cwb.googlegroups.com>

 >>doubt that holding off on the amoxicillin for another 12-24 hours will
matter much.  I would do so until you can get in to see the doc. <<

Agree. There's a bitter debate between the US and Europe whether
antibiotics even influence the clinical course of strep throat, enough
to give. Our studies say yes, theirs say no. Jury is out. But meanwhile
a day won't make much difference.

By "hives" (aka urticaria) I presume you mean mosquito-bite looking
bumpy things with whitish interiors and red rings. Dime to quarter size
or larger. Not just a flat rash.  If she has hives, I would certainly
stop the antibiotic!  Get a second opinion.

If it's a flat rash like measles, she might have mononucleosis. This
gives a rash 10% of the time, but it goes up to 80% if you give
amoxicillin. It's not really an allergy, though, and it shouldn't look
like hives.

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med
Subject: Re: Scarlet Fever?+Amoxicillin=Hives?
Date: 5 Apr 2005 15:36:23 -0700
Message-ID: <1112740582.986933.155750@f14g2000cwb.googlegroups.com>

Yes, it is unfortunately that just about anything can trigger hives--
strep, other bacteria, viral infections, allergies, looking cross-eyed
at a hive-prone person.

With a rash, it's probably not a drug allergy. With hives you don't
know what it is-- it could be a drug allergy especially with pen or
sulfa, and are obligated to stop the antibiotic. Now the question is
whether to replace it with another.

It's always a bad situation if you do a strep test after you start the
antibiotic. If you're going to ignore the result if negative, why do it
at all? You should save the money for the strep test if you're going to
treat no matter what it says.

I suppose the lesson is that, if the major reason by most antibiotics
are to be given to children with sore throats is to prevent rheumatic
heart disease, then everybody should be strep-tested from the word go.
And since adults don't get rheumatic fever from sore throats, we can
pretty much quit given them antibiotics for sore throats also (unless
we see giant pus-filled tonsils or something very impressive.  Maybe).

And we've got to stop all this giving of amoxicillin for earaches and
undiagnosed sore throats. Even if it is cheap; it's NOT a good placebo.
Because it just causes more trouble than it's worth, and this case
neatly illustrates why.

SBH

From: PF Riley <pfriley@watt-not.com>
Newsgroups: sci.med
Subject: Re: Scarlet Fever?+Amoxicillin=Hives?
Date: Mon, 04 Apr 2005 00:31:49 -0700
Message-ID: <iup151hsc8lfr508mamms2ctrabv5m48rj@4ax.com>

On 2 Apr 2005 21:30:08 -0800, "rehsurq@yahoo.com" <rehsurq@yahoo.com>
wrote:

>My 6-year old [daughter] had a sore throat last Sunday (3/27). Monday
>and Tuesday she woke up with a mild fever and sore throat, which
>seemed to disappear with a dose of IB. Late Tuesday and Wedesday her
>fever shot up over 102, so we took her to the doctor Wednesday. He
>said she had an ear infection and prescribed Amoxicillin. We gave her
>one dose Wednesday night, 3 doses Thursday, and one dose Friday
>morning before school. After school she said she was very itchy and
>did appear to have hives only on her back, so we gave her some
>Benadryl and took her to the doctor (we could only get in to see a
>different doctor than before). This doctor said it was probably
>scarlet fever, did a swab test, and it turned up *negative.* Doc
>thought it might still be strep but the amox was leading to the
>negative result, and urged us to continue the amox. Doc said her
>tongue and skin made her believe it was scarlet fever, and said her
>ear and throat were both still red. Saturday we resumed the
>amoxicillin, and her hives returned again, this time on her back,
>stomach, legs, and arms. We gave her Benadryl and it worked well
>again.
>
>I don't know much at all about scarlet fever, but I do know hives when
>I see them (my son has a nut allergy - I've seen hives). I didn't think
>scarlet fever is supposed to have *hives* but a more of a rash. Now I'm
>wondering if maybe it is the amoxicillin itself. My daughter hasn't had
>it in several years, though before there were no problems. I realize
>that people can become sensitive to it even if they weren't before.

A scarlatiniform rash is a fine, dry, bumpy, red rash with a
"sandpaper" texture with a characteristic distribution. It does not
come and go, it is usually not itchy, and does not respond to
Benadryl. Hives, however, are variably sized and shaped rashed, red
areas as descrbied by Dr. Harris that do come and go, usually itch,
and can completely disappear temporarily with Benadryl.

>Now to my questions...
>Would it be a bad idea to hold off the amox on Sunday until I can get
>her back into see her regular doctor (the one who saw her in the first
>place) on Monday? If I hold off the amox on Sunday and the hives return
>anyway, would that mean it probably is scarlet fever? Any other
>thoughts?

Here's my guess as to what most likely happened (assuming she had no
other symptoms prior to or concurrent with the sore throat and fever):

Child gets a virus infection, develops the prodrome of sore throat,
and subsequent fever. Child is seen and the eardrum is "red" and thus
is diagnosed with an ear infection, even though the child did not have
the typical antecedent cold symptoms nor an ear ache. The child is
then treated with an antibiotic for a viral illness.

Then, as is common in children, the virus causes hives. (I would
disagree with Mr. Gregory that hives "are definitely a sign of
allergic reaction".) Some diagnostic confusion ensues, and the
antibiotic is continued. The hives wax and wane as they are wont to
do.

Or, perhaps it truly is an amoxicillin allergy. We'll likely never
know.

Side note: Some happy news is that because these days a lot fewer kids
are treated with an antibiotic at the beginning of a viral illness
than were just a few decades ago, we are growing a new generation of
Americans who are not afflicted with epidemic "penicillin allergy",
since it seems that all the viral rashes in children of the 1960's and
1970's occurred while they were taking antibiotics, and they were thus
branded so. It's no wonder why, consistently in several studies, only
about 4% of adults who think they are "allergic" to penicillin
actually are.

What would I do with this child if she presented to my office? As Dr.
Harris pointed out, antibiotics don't really do much to modify the
course of streptococcal pharyngitis, which is largely a self-limited
illness (a fact few parents know). However, the main reason for
treating strep throat with antibiotics is to prevent rheumatic fever,
which was the most common cause of acquired heart disease in children
and young adults prior to the antibiotic era. (Would anyone like to
guess what has become the number one cause now?) If the only history I
had was fever and sore throat, but a strep swab was obtained only
after starting antibiotics, there is a small but real risk of
rheumatic fever from discontinuing antibiotics. One is thus obligated
to complete a treatment for strep throat. With the presence of hives,
however, which could be from the amoxicillin, the risk of continuing
amoxicillin is producing anaphylaxis. I would thus switch her to
either azithromycin or cephalexin. She would then get better, the
hives would go away, we would label her chart "allergic to
amoxicillin" and we'd never really know if she really is allergic to
amoxicillin or if she had strep throat or not. But at least she'd be
all better.

As for stopping the antibiotics until she can be seen again: Treatment
of strep throat should commence within 10 days of onset to effectively
prevent rheumatic fever. There is usually plenty of time. As I often
say, there are very few good reasons to take an antiobiotic, but many
good reasons not to.

PF