Home strep tests: sore point for some

April 04, 1999|By Julia Keller | Julia Keller,Chicago Tribune

In a retail world offering home tests for pregnancy, AIDS, high blood pressure and ear infections, why can't somebody de- velop a cheap, reliable home test for that ubiquitous tribulation of childhood, strep throat?

Somebody can. In fact, somebody has. But infectious-disease specialists want to keep it out of your medicine cabinet.

Strep, the diminutive for a bacterial infection called beta hemolytic streptococcus, is especially troublesome for parents at this time of year, when it most frequently infects young children.

Most sore throats are caused by minor viral infections, which heal by themselves. In a few cases, however, a sore throat may indicate strep, which, if untreated, can lead to rheumatic fever and irreversible heart and kidney damage.

Many a parent, therefore, agonizes when a child complains of a raw, scratchy throat: Is it just a harmless virus or is it strep?

Only an often inconvenient trip to the doctor can confirm the latter; if the strep test is positive, antibiotics such as penicillin or alternatives such as erythromycin are prescribed.

(The problem has been compounded this winter by a tougher version of the streptococcus bacteria that has "popped up," said Dr. Jon Abramson of the Wake Forest University School of Medicine in Winston-Salem, N.C.)

So why don't researchers save parents time and money by marketing a home strep test? If the results were positive, parents could simply call their pediatrician and request an antibiotic prescription over the phone.

Dr. Michael Gerber, who researches strep tests for the National Institutes of Health out of his office in Washington, winces at the idea. He and his colleagues, in fact, have beaten back several attempts by drug companies to release one.

"I feel very strongly that it would not be a good idea," he declared. "It's not the technical aspect of the test -- in a recent experiment, sixth- and seventh-graders were able to perform it -- it's the decision about who to perform the test on."

Gerber explained that a large number of children are strep carriers. "They're not ill; they are at little risk of passing it on. They may carry it for a year or more."

Even when they come down with a sore throat, the cause is not the bacteria, but the same old harmless virus that produces the sandpapery throat in the majority of people.

Even physicians and their staffs, well trained in reading the results of strep tests, can misdiagnose a child's sore throat and prescribe antibiotics, Gerber said.

That creates a dilemma: "overdiagnosis of strep and overprescription of antibiotics," he said.

Instead of widening the pool of people who can administer strep tests by, say, releasing a home version, Gerber would prefer to limit it. He advocates better training for physicians so that they would recognize the crucial distinction between strep bacteria that are merely carried in the throat and that which are dangerously active.

"If a parent has access to a test at home, every time a child wakes up with a tickle in the throat, they'll do a test," Gerber said.

If a home strep test delivered a positive result, parents would probably skip the doctor visit and just request an antibiotic prescription by phone, he predicted. "You look where antibiotics are overprescribed, and sore throats are a tremendous area."

'Breaking the Antibiotic Habit'

As sickness continues pestering us into the spring, we still find ourselves facing the antibiotics-or-no-antibiotics question.

Help arrives April 23, in the form of "Breaking the Antibiotic Habit: A Parent's Guide to Coughs, Colds, Ear Infections, and Sore Throats" (Wiley, 1999, $12.95). The guide teaches how to recognize the difference between viral and bacterial infections. It is written by Paul A. Offit, chief of infectious diseases at Children's Hospital of Philadelphia; Bonnie Fass-Offit, medical director of Kids First-Haverford/Radnor in Philadelphia; and Louis M. Bell, an infectious disease specialist at Children's Hospital.

The book aims at preventing unnecessary antibiotic use, as well as relieving the symptoms of bacterial infections. According to the authors, a bit of know-how can help patients avoid the wear and tear of antibiotics without placing their own health and their children's at risk.

Not a bad idea, considering the lines at drugstores these days.

-- Joe Capista

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