Don’t get scared; it is about about the high dose of penicillin

The letter below is from a colleague[specialist]

Dr Haold

It is amazing! I had never heard of it and I think I just got that! 

I am prone to Strep infection and we all got a virus in the family starting with my son then my husband so when I got a sore throat I thought OK I got the virus and ignored it, then it got worse with a high fever (39.5) and horrible chills, it would not go away despite Advil and Excedrin and Optalgin , strep culture was negative… I had to fly to France so after 3 days of horrible pain in my throat -could not swallow it was terrible on one side especially, and high fever, and I started myself on Zinnat since I am allergic to Penicillin. I was so sick that I fainted in the plane !!! (waiting for the bathroom standing in the corridor, I found myself on the floor not remembering how I got there! They brought me a bottle of Oxygen and were very worried. I survived but I had not been sick like that for 20 years in my life, and I am usually very healthy….  And I am almost 59 yo, could it have been that? Difficult to prove I guess but I could not believe that a virus got me so sick…. Thank you for your original info as usual! How does one diagnose it? Do you ask for a special culture? If I do a real throat culture (not the quickie done by the pediatrician who has a kit for strep) and ask for this specific microb, will they tesi t inKupat Cholim?

You should be blessed always!

It must be somewhere in the eighties [1973-76] that I read a fascinating story in the “Practitioner” [one of the best original medical journals at that time in my opinion ]

I tend to keep all old medical literature but don’t have this journal anymore.

The writer stated in that journal that many serious throat infections are not bacterial [“STREP”] but likely of another origin [I think the writer said even that many are virus infections!!] but even so react very well to penicillin.[in his experience]

Since then I have treated serious throat infections often with penicillin without bothering doing cultures![bacterial or not]

I have used since long “high doses” of penicillin for a short time, for example, 4 to 5 grams 2x per day for 2-3 days and it always worked well. [5 gram = 10 tablets of Rafapen [Pen-rafa] at once], yes that amount of tablets as Misrad ha-Briut [or the producer?] in their “eternal wisdom” took one gram tablets from the market.]
In Israel, doctors are giving much lower doses and this often does NOT work.

In the light of what I wrote above the story below is fascinating [and important] at least for me.

Sore Throat Misdiagnosis Could Kill Teenagers

Doctors often culture a bad sore throat for strep. If the results are negative they may miss a very serious infection called F. necrophorum or F-throat.

The People’s Pharmacy February 19, 2015 Health ConcernsAdd a Comment

man with sore throat

Doctors are taught that a really bad sore throat should be cultured to determine whether it is caused by a group A beta-hemolytic streptococcal infection (aka strep throat).

If the test comes back positive, the patient is treated with an antibiotic because untreated strep sometimes triggers rheumatic fever. 

[ my remark: I wrote to you probably in the past about this misconception and why everybody in Israel is driven mad with antibiotics!! when they will not help]

If the test is negative, the patient is often sent home and told to wait for the discomfort to disappear.

Many physicians are not aware of another kind of sore throat caused by Fusobacterium necrophorum (aka F-throat). A new study in the Annals of Internal Medicine (Feb. 17, 2015) suggests this F-throat infection is more common than strep throat among adolescents and young adults. It is not as easily diagnosed because the routine throat culture carried out in a doctor’s office will not catch it. Untreated, F-throat can cause severe illness or even death.

How Common is F-Throat?

The researchers recruited 312 students at a university health clinic who arrived complaining of a “sore throat.” The scientists used a sophisticated PCR (polymerase chain reaction) test to tell what kind of bacteria might be causing the sore throat symptoms. What they found was a game changer.

One-fifth of the students had F-throat. Half as many (10 per cent) had strep infections. What this means is that a surprisingly high number of sore throats in young adults are caused by F. necrophorum bacteria. In fact, it was the most common bacterium triggering sore throat symptoms in this college population.

Diagnostic Disaster

What this means is that current diagnostic practices will not catch this common and potentially deadly infection. Doctors have guidelines for treating strep throat. There are no guidelines for treating F-throat. That means that most physicians do not know what the best antibiotic treatment is for F-throat; that lack of knowledge could be disastrous.

Deadly Lemierre’s Disease from F-Throat

Let us tell you a story we heard from Lisa Sanders, MD. She writes the “Diagnosis” column for the New York Times Magazine. In one of her articles (and also in an interview on our radio show) she related the case of a 17-year-old boy who developed a fever and sore throat. Because he was so sick, his mother took him to the family physician promptly after his symptoms worsened.

The doctor diagnosed strep throat (without a culture) and prescribed a macrolide antibiotic called azithromycin (ZithromaxZmax). It usually works well for strep throat. But instead of getting better, the young man continued to run a fever with shaking chills and his sore throat got substantially worse, localizing on one side of his neck.

The parents took him to the emergency room of the local hospital, but the ER physicians didn’t consider F-throat either. The antibiotics they prescribed didn’t work against F-throat. By the time the doctors figured out that the infection was caused by F. necrophorum and he had developed Lemierre Syndrome, it was too late. The young man died because of a misdiagnosis and inadequate treatment.

Should you be Worried about F-Throat?

Physicians have been taught that F-throat is relatively rare and that if it occurs it primarily affects teenagers or young adults up to the age of 30. But Lisa Sanders described a case of a 44-year-old mother who developed F. necrophorum. The only reason she was correctly diagnosed was because her ear, nose and throat specialist couldn’t figure out what was happening and consulted an infectious disease expert. This specialist recognized F-throat and recommended the antibiotic that saved her life.

The new study in the Annals of Internal Medicine established that F-throat is twice as common as strep throat, at least in a college-age population. Although Lemierre syndrome is relatively rare, it is such a serious condition that it must be diagnosed promptly and treated correctly. Penicillin or metronidazole are more appropriate than antibiotics like azithromycin, ciprofloxacin, erythromycin or tetracycline.

How to Recognize F-Throat

As we have already described, the traditional diagnosis with a routine throat swab and culture is not going to catch F-throat. Clues to report to a physician include:

  • A bad sore throat that does not get better after a few days
  • A fever
  • Night sweats and shivering
  • Pus in the back of the throat
  • Swollen glands in the neck
  • Swelling in the neck, especially on one side

If you suspect that you or someone you love has F-throat, encourage your physician to consider this diagnosis. Make sure that she does her homework on Fusobacterium necrophorum and knows how to treat it appropriately.

This is just one example of how misdiagnosis can cause irreparable harm or death. Surprisingly, misdiagnosis is far more common than most people realize. Some experts estimate that diagnostic error rates are as high as 15 percent in clinical medicine.

You will read about the “Top 10 Reasons Why Doctors Screw Up Diagnoses” in our book, Top Screwups Doctors Make and How to Avoid Them. You will also discover the“Top 10 Questions to Ask to Reduce Diagnostic Disasters.” And you will find out the about the most common diagnostic errors to watch out for in Top Screwups.

Do not let F-throat or other common conditions go misdiagnosed. Protect yourself and those you love with knowledge.

Please share your own story below and vote at the top of this article.