“He has pus on his tonsils, so it’s probably strep,” said a guest, calling about her teenage son. I hear this phrase regularly. It causes me some stress because I know that later I might find myself delivering a why-antibiotics-won’t-help explanation to a disappointed audience.
One popular (i.e. wrong) medical belief is that pus on tonsils is a sign of strep throat. In fact, this is true only ten to twenty percent of the time. Viral infections produce identical exudates.
Arriving in the room, I discovered that the boy had pus on his tonsils but also a fever, swollen, painful glands on his neck, and no cough. Good scientific studies show that the presence of these four signs: pus on tonsils, fever, swollen neck glands, and NO cough raise the odds of strep to over fifty percent, so prescribing an antibiotic is appropriate. I prescribed an antibiotic. The family made it clear they were in the presence of an astute physician who knew what to do. Everyone was happy.
Isn’t science wonderful? The answer is yes. But it’s wonderful in ways that are often not satisfying. More in my next post.