About 8 weeks I was diagnosed with strep throat (after a rapid strep test) and placed on Penicillin. I believe I caught it from my girlfriend's two year old.

The Penicillin seemed to work initially, removing the burning feeling that I associated with the Strep. However after the 3rd or 4th day on the anti-biotic, I developed a severe sore throat. Note: it was also during this time frame that I missed a mid-day dosage of the Penicillin. This sore throat was different than the original strep feeling, was much more severe (hard to swallow, etc.) and seemed to be lower in my throat. I consulted with my Physician's nurse and she told me to continue the rest of the perscription.

The sore throat subsided somewhat, but never went away but did seem to get better. About two days after the initial perscription was done, I contacted the doctor and indicated that the sore throat was still there. I was again perscribed Penicillin. This time however, the severe sore throat pain came back immediately. I went and saw the Physician after four days of taking Penicillin and had a negative rapid strep test. As a precaution, he had me switch to Zithromax and quit taking the penicillin. This seemed to work and I felt normal for about a week or two.

Recently, the two year old was diagnosed with strep again and I again developed a sore throat (the burning, tingling, strep kind). I contacted the doctor's nurse again. She consulted with the doctor and indicated to me that the doctor felt Penicillin was the best way to treat this. He put me on a 10 day double dose of penicillin (1000mg twice a day) and a 60 day single dose. I started with the Penicillin and again got the severe sore throat feeling, this time accompanied by a constant low grade fever (99-100.5).

After three days on the Penicillin, I went and saw a urgent care doctor at my HMO. She gave me a rapid strep test which was negative, took a full throat culture, and put me on Biaxin, plus a strong antihisteme until the culture comes back. I'll get the results back on Tuesday. My sore throat is still here after 2 days on the Biaxin, however the fever seems to have subsided.

My questions.

1. Do these symptoms sound like anything specific? I am going on a long-awaited vacation at the end of next week and would like to get this thing resolved.

2. Does Penicillin have side effects related to sore thoats and fevers? It seems strange to me that I have only developed the severe sore throat after the Penicillin.

3. Is a long dosage of penicillin like I was prescribed normal? I thought this was an old/outdated practice.

4. Is it possible that I am the carrier of strep and am infecting the 2 year old? In all cases, she seemed to show symptoms a day or 2 before I did. I am worried because this last time, she also had pneumonia and is now under treatment for potential damage to her lungs.

Would appreciate your thoughts.

Reply: -----------------------------

1. Your symptoms sound consistent with a diagnosis of infectious pharyngitis.
2. I have never seen penicillin cause sore throats as a side effect. This does not mean that it can't happen, but it would not be considered likely. On the other hand, it is possible to develop a yeast infection known as candidiasis following antibiotic therapy. Oral or pharyngeal candidiasis should be relatively straightforward to diagnose in most instances simply by physical examination of the membranes in the throat - candidiasis causes a diffuse white coating commonly referred to as thrush.
3. If you are referring to the single dose injection of a long-acting penicillin, this is still done occasionally. Most of the time, treatment is limited to 7-10 day courses of oral antibiotic.
4. If you have had negative strep screens, then you probably are not a carrier of strep.

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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis

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