Practice guidelines
Strep And Mono Coinfection Treatment: What To Expect
Strep and mono are both infectious illnesses. However, they occur for different reasons. Strep throat is a bacterial infection, so treatment may involve a course of antibiotics. Mono is a viral infection, so antibiotics will not cure it.
Mono typically gets better on its own, though it can take time. Treatment generally consists of supportive measures, such as rest and hydration, to help relieve symptoms.
This article discusses strep and mono coinfection treatment, including how quickly it can work and tips for recovery.
Yes, it is possible. A 2012 case study states that strep throat and mono can occur at the same time. However, it notes that coinfection is uncommon.
Strep is an informal name for Streptococcus, which is a type of bacteria. There are many species of Streptococci. Group A Streptococcus is the type most commonly responsible for strep throat.
In contrast, mononucleosis (mono) is a viral infection. It typically occurs because of the Epstein-Barr virus (EBV), though other viruses can also cause the disease. Other names for the disease include kissing disease and glandular fever.
It is possible for a person to get both mono and strep throat around the same time, or they may develop strep throat secondary to mono.
Below are the standard treatments for mono and strep throat.
Strep throat
However, if a person contracts strep throat and does not have symptoms, they typically will not need antibiotics.
Mono
Antibiotics will not help with mono. If a person has both mono and strep throat, antibiotics will ease the strep throat.
There is no prescription medication that can cure mono. The illness typically gets better on its own. In the meantime, treatments to ease symptoms include:
People should avoid contact sports until they recover fully from mono, as the infection can sometimes cause spleen enlargement. This increases the risk of a rupture if a person receives a blow to the abdomen.
Most courses of antibiotics for strep throat last 10 days. After starting an antibiotic prescription, individuals with strep throat should begin feeling better in 1–2 days. It is important to take the entire course of antibiotics, even if the symptoms go away.
If a person's symptoms do not start reducing after 48 hours, the person should contact a doctor.
If antibiotics do not work, there are a few potential explanations.
Firstly, a person may need a different type of antibiotic. There are several doctors use for strep throat. They may suggest trying another type or taking it for a longer period of time.
Another reason antibiotics may not work is if a person only has mono. Mono can cause a sore throat, fever, and other symptoms that are similar to a throat infection. If a virus such as EBV is the cause, antibiotics will not treat it.
It is also possible that something else is responsible for the throat symptoms. A 2022 article states that aside from bacterial and viral infections, many other conditions can produce symptoms similar to strep throat. Some examples include:
If strep throat-like symptoms persist, a doctor may run additional tests to determine the cause.
Strep and mono coinfection treatment may include antibiotics for strep throat. However, antibiotics will not help with mono. Instead, doctors advise getting plenty of rest and fluids until the virus clears on its own.
Antibiotic treatment for strep throat typically lasts 10 days. Once treatment begins, the strep throat will likely get better quickly. Even if symptoms go away, it is still important to finish the course of antibiotics.
Recovery from mono can take longer than recovery from strep. Mono can also cause a sore throat and swollen glands, which may seem similar to strep throat. If prescribed antibiotics do not work, a person should speak with a doctor about their options.
Strep Throat Can Easily Be Confused With Throat Infections Caused By ...
"My sore throats, you know, are always worse than anybody's."
So declares Mary to Anne in "Persuasion," Jane Austen's 1817 book. Most of us can relate to this feeling. There is no such thing as "just a sore throat." The pain, headache, fever and aches associated with a sore throat can make you feel terrible.
While sore throats can occur at any time of year, strep throat is more common in the fall, winter and early spring.
I am a professor of family medicine, a pharmacist and an expert on evidence-based medicine. My work involves the evaluation of research performed by others, and I have been following and analyzing research findings on strep for the past 30 years.
Many people incorrectly assume that all sore throats are due to strep throat, a bacterial infection of the pharynx, the middle throat area behind the nose and mouth, and patients often come to our family medicine office wanting to be checked and treated for strep with antibiotics.
However, neither testing nor treatment is always needed for a sore throat. Regardless of the cause, rest and pain relievers form the cornerstone of sore throat treatment.
Here's some guidance on whether and when testing is necessary.
Bacterial versus viral sore throatsMost sudden-onset sore throats are caused by viruses – the same ones that cause the common cold, the seasonal flu and COVID-19. There are more than 200 viruses that can cause sore throat and other symptoms related to the common cold.
But bacteria can also be the culprits behind a sore throat. One of the most common examples is strep throat, or group A pharyngitis.
Strep is caused by certain strains of Streptococcus pyogenes bacteria. There are many species of strep; other common forms of strep that cause different infections in humans include "group B strep" and "group D strep." Group A strep usually lives peacefully among the many other types of bacteria growing on our skin and doesn't cause any problems, until we get a break in the skin such as a cut or a scrape. This allows it to overwhelm the immune system's ability to keep it in check.
Group A strep can also live in the back of the throat – up to 30% of people without any evidence of a sore throat will have this strain in their throat. Up to 3 in 10 children and 1 in 10 adults feeling sick with a sore throat due to a virus or other cause will test positive for group A strep. That means that people with a sore throat caused by a virus could also be positive for strep, even if it's not causing the symptoms.
Not all group A strep bacteria are the same, though. Some varieties are better at evading the immune system than others and can grow quickly. Others produce byproducts that can cause a sore throat and sometimes lead to tonsillitis, an infection of the tonsils, or cause ear or sinus infections.
Still other strep strains produce a toxin that can cause a characteristic skin rash or lead to effects on the heart, kidneys or even the brain.
Rarer still, group A strep can enter the bloodstream and cause toxic shock syndrome, a life-threatening, overwhelming infection. These latter conditions are examples of invasive strep, meaning that the infection is in parts of the body typically free from germs; they seem to be on the rise after a marked reduction in their occurrence during the COVID-19 pandemic.
To test or not to testDoctors or other clinicians can easily test for strep by using a swab to collect a bit of the fluid from the back of the throat. This sample can identify group A strep in about a minute.
While researchers have been studying group A strep for over 75 years and there are thousands of research papers focused on infections caused by strep, there is still controversy over whether it needs to be tested for and treated.
To decide whether to test for group A strep, clinicians use a set of criteria based on five questions that can help determine whether strep testing is needed. These are:
• How old is the patient? Strep throat is most common in children between ages 5 and 15 and least common in adults over age 45.
• Are the tonsils swollen or do they have a white or yellow coating? Both conditions often accompany strep. However, this question alone isn't definitive, since viruses can also affect the tonsils.
• Are the cervical lymph nodes swollen or tender? Normally these bumps, which are in the front of the neck along the sides of the windpipe, cannot be seen or felt, but are often palpable when strep is present.
• Does the person have a fever? Lack of a fever makes strep less likely.
• Does the person have a cough? A cough is indicative of a viral cause and makes strep the less likely cause of the sore throat.
While none of these questions alone can provide a clear answer, taken together they can tell your clinician whether strep is more or less likely.
Using this scoring tool, an adult with a sore throat but without changes to the tonsils or lymph nodes, without a fever and with a cough has only a 1 in 40 chance, or 2.5%, of having strep throat. For such patients, a strep test is not necessary.
On the other hand, when a first grader meets all five of these criteria, there is a 50% chance that strep is causing his or her sore throat. Based on recent research I have reviewed, by using these questions adults can determine when strep is the likely cause of a sore throat.
In the United Kingdom and other European countries, doctors do not routinely test for strep. Antibiotic treatment can at times cause allergic reactions, rash, diarrhea, stomach upset, yeast infections and other side effects. Authorities in these countries feel any benefit of testing and treatment does not outweigh these risks.
Treatments for strepOnce group A strep is confirmed, doctors may prescribe an antibiotic treatment.
Penicillin or amoxicillin are the most commonly prescribed antibiotics for strep. These medicines will not reduce pain or tiredness but may help symptoms resolve earlier, typically by about a day. Doctors may also suggest use of a pain reliever such as acetaminophen or ibuprofen to help relieve symptoms.
Antibiotic treatment does not seem to lower the likelihood of spread of the infection between children – which is common in schools and dormitories – or adults.
Health care practitioners recommend staying home until fever has subsided. They also recommend taking the full course of antibiotics, even if the symptoms have abated.
With sore throats causes by viruses – against which antibiotics are ineffective – few treatments exist aside from using pain relievers to help soothe immediate symptoms. For this reason and because antibiotic overuse is a major problem in the U.S., it is best not to assume that your sore throat is caused by strep and to treat it accordingly.
Allen Shaughnessy, Professor of Family Medicine, Tufts University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Why Antibiotics May Not Help Patients Survive Their Viral Infections ...
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Most patients who are admitted to hospitals with acute viral infections are given antibiotics by their doctors or health care providers as a precaution against bacterial co-infection.
Yet new research suggests this practice may not improve their survival rates.
Researchers investigated the impact of antibiotic use on survival in more than 2,100 patients in a hospital in Norway between the years 2017 and 2021, Reuters reported.
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The researchers found that giving antibiotics to people with common respiratory infections was unlikely to lower the risk of death within 30 days.
At the height of the COVID-19 pandemic, antibiotics were prescribed for around 70% of COVID-19 patients in some countries, Reuters also said.
Researchers found that giving antibiotics to people with common respiratory infections was unlikely to lower the risk of death within 30 days. (iStock)
This potentially has contributed to the scourge of antibiotic-resistant pathogens known as superbugs.
The new data has not been published in a medical journal to date.
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It suggests that there is "a huge overuse of antibiotics," said lead author Dr. Magrit Jarlsdatter Hovind from Akershus University Hospital and the University of Oslo, Norway, according to Reuters.
It suggests there is "a huge overuse of antibiotics."
Microbes have become resistant to many treatments, given the overuse and misuse of antibiotics.
Scientists consider this development a tremendous threat to global health, given that the pipeline of replacement therapies in development is alarmingly sparse, Reuters also noted.
Research will be presented next monthThe latest research is to be presented at next month's European Congress of Clinical Microbiology & Infectious Diseases in Copenhagen.
It involved patients who tested positive via nasal or throat swab for viral infections such as the flu, RSV or COVID-19.
Those with confirmed bacterial infections were excluded from the analysis.
In total, 63% of the 2,111 patients received antibiotics for their respiratory infections during their hospital stay.
The new research involved patients who tested positive via nasal or throat swab for viral infections such as the flu, RSV or COVID-19. (iStock)
Overall, 168 patients died within 30 days — of which only 22 had not been prescribed antibiotics.
After accounting for factors such as sex, age, severity of disease and underlying illnesses among the patients, the researchers found those prescribed antibiotics during their hospital stay were twice as likely to die within 30 days than those not given antibiotics.
"Doctors have to dare to not give antibiotics, instead of doubting and giving antibiotics just in case."
Both the sicker patients and those with more underlying illnesses were more likely to get antibiotics and to die, the research team noted.
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Other factors such as patients' smoking status could have also played a role, they said.
"Doctors have to dare to not give antibiotics, instead of doubting and giving antibiotics just in case," Hovind said, according to Reuters.
Should patients admitted to the hospital with common respiratory infections be treated with antibiotics? A new study is seeking to determine the answer. (iStock)
There are limitations of a retrospective study such as this one.
It is why a clinical trial, which Hovind and colleagues recently initiated, is needed to determine whether patients admitted to the hospital with common respiratory infections should be treated with antibiotics, she said, as Reuters reported.
Tackling the shortages of antibioticsMeanwhile, in late January 2023, a group of European patient and consumer groups told the European Union's drug regulator that it needs to do more to tackle shortages of some widely used antibiotics in the region, according to a letter sent and reviewed by Reuters.
The letter to the European Medicines Agency (EMA) comes as antibiotics, including amoxicillin, have been in short supply since last October, as Reuters reported.
There has been a spike in demand for certain drugs linked to the resurgence of respiratory infections after two years of COVID restrictions, said Reuters. (iStock)
The letter said measures like substituting amoxicillin with other antibiotics have squeezed supply of some other drugs — and that the current steps in place to deal with the shortages have not contained the crisis.
There has been a spike in demand for certain drugs linked to the resurgence of respiratory infections after two years of COVID restrictions, putting extra pressure on global supplies.
At the height of the COVID-19 pandemic, drugmakers cut output.
Drugmakers also cut output when demand dipped at the height of the pandemic.
But the letter highlighted growing concerns about prolonged shortages in the region even as the winter comes to an end.
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In another recent study on a related topic, children who contracted lower respiratory tract infection (LRTI) at two years of age or younger were found to be more likely to die prematurely from that same condition as adults.
These types of infections were linked to one-fifth of the deaths.
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The study was conducted by a group of London researchers and led by Dr. James Peter Allinson of the National Heart and Lung Institute at Imperial College London. It was published in The Lancet in early March.
The eight-decade study analyzed data from the Medical Research Council National Survey of Health and Development, which followed 3,589 participants in England, Scotland and Wales all born in March 1946.
Melissa Rudy of Fox News Digital, as well as Reuters, contributed reporting to this article.
Maureen Mackey is managing editor of lifestyle at Fox News Digital.
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