Do You Really Need Antibiotics for Strep Throat?

When that scratchy, painful feeling in your throat strikes, the most likely culprit is a virus. These microscopic organisms are responsible for the flu, COVID-19, RSV (respiratory syncytial virus), the common cold, and other ailments, too.

But there’s a chance you have strep throat, a bacterial infection.

Does the reason for your throat pain really matter? To put it simply, yes. Unlike viral sore throats, strep throat should almost always be treated with antibiotics.

Keep reading to find out what makes strep throat unique, why timely strep throat treatment is important, why completing the full course of antibiotics is essential, and how to manage common antibiotic side effects like diarrhea.

Strep Throat Is Caused by a Specific Type of Bacteria

“Strep throat is a bacterial infection caused by group A Streptococcus bacteria,” says Lyndsay Leigh Madden, DO, an otolaryngologist at Atrium Health Wake Forest Baptist in Winston-Salem, North Carolina.

Strep throat is spread by person-to-person contact with fluids from the nose or saliva, according to Penn Medicine in Philadelphia.

Symptoms of Strep Throat Versus Sore Throats Caused by Viruses

Strep is generally marked by sore throat, painful swelling in the throat, and fever, says Lauren Bohm, MD, an otolaryngologist and a clinical associate professor of otolaryngology at Michigan Medicine in Ann Arbor. “Other symptoms may include headache, abdominal pain, nausea, and vomiting, which are more commonly seen in children,” she says.

The fever often starts suddenly and is typically the highest on the second day.

Other distinguishing features of strep throat are white patches or streaks of pus on red and swollen tonsils, tiny red spots on the roof of the mouth (petechiae), and swollen lymph nodes in the neck, according to the Centers for Disease Control and Prevention (CDC).

A sore throat caused by a virus may result in a different range of symptoms. If the sore throat comes with a runny nose, cough, hoarseness in the voice, or pink eye (conjunctivitis), it’s more likely viral than bacterial, says Dr. Bohm.

When to See a Doctor for a Sore Throat

Viral sore throats usually start to get better within five days, according to UCLA Health. If symptoms don’t improve or fever remains 101 or higher for a few days, it’s a good idea to see a doctor to get tested for strep.

Types of Tests for Strep Throat

Healthcare providers will give you a physical exam and ask about your symptoms to see if strep throat is a possibility. If they think you might have strep, there are two types of tests that confirm this diagnosis: a rapid strep test and a throat culture.

Both tests require swabbing the throat. While the rapid test gives results right away, it’s not quite as accurate and can miss some cases of strep. A throat culture typically takes 24 to 48 hours to see if group A strep grows from the swab.

Antibiotics Cure Strep Throat and Prevent Complications

Strep throat can be treated very effectively with antibiotics, says Shengyi Mao, MD, a pediatrician and an internal medicine doctor at the Ohio State University Wexner Medical Center in Columbus.

“Antibiotics help speed up the recovery, decrease the spread of the disease to others, and most importantly, prevent complications like rheumatic fever or abscess,” which are rare but serious, says Dr. Mao.

Rheumatic fever causes inflammation and damage to the heart, she says. It is mainly a danger to children, according to the CDC. A peritonsillar abscess, caused by the same bacteria that result in strep throat, is a swollen pocket of pus that typically forms near one of the tonsils and causes persistent pain on one side of the throat, per the Icahn School of Medicine at Mount Sinai in New York City.

It’s also important to finish taking the full course of antibiotics specified by your doctor or pharmacist, even if you start to feel better, warns the CDC. Stopping early could lead to recurrence or complications like the ones described above.

There is one uncommon situation in which a person who tests positive for strep would not be prescribed antibiotics: “The main exception is if a patient is an asymptomatic carrier — this means a person may carry the bacteria chronically in their throat, but it’s not causing a problem,” says Mao. In that case, the person wouldn’t need any form of treatment, she notes.

Are There Any Options for Treating Sore Throat Besides Antibiotics?

Antibiotics are the primary and most effective treatment for strep throat, as this medication targets bacteria directly, says Dr. Madden.

“While supportive measures like rest, hydration, and over-the-counter pain relievers may alleviate symptoms, they don’t address the underlying bacterial cause,” she says.

Will Antibiotics Help if My Sore Throat Isn’t Strep?

Antibiotics won’t help your symptoms or make you feel better if your sore throat isn’t strep.

“Antibiotics are only effective against bacterial infections, not viruses. Viral sore throats, often associated with the common cold or flu, don’t respond to antibiotics,” says Madden.

Unnecessary Use of Antibiotics Contributes to Antibiotic Resistance

Overuse of antibiotics can lead to antibiotic resistance, when bacteria evolve to become resistant and the drugs stop working, says Mao. “Then we are left with fewer options to treat infections.”

Antibiotic resistance, which is part of a larger issue called antimicrobial resistance, is an “urgent global public health threat,” according to the CDC. In the United States, more than 2.8 million antimicrobial-resistant infections occur each year, and more than 35,000 people die as a result.

Antibiotics for Strep Can Cause Side Effects Like Nausea and Diarrhea

Like any other medication, antibiotics can have side effects, says Mao. “Up to 20 percent of people who take antibiotics will have an adverse effect, so it’s a serious concern,” she adds.

These side effects include nausea, diarrhea, and hives. There’s also evidence that antibiotics can adversely affect gut health and reduce microbiome diversity, because in addition to killing “bad” bacteria that cause strep, they can also wipe out “good” bacteria in your digestive system.

If you have diarrhea caused by antibiotics, make sure you stay hydrated with water or an electrolyte-containing drink such as Pedialyte or Gatorade, says Mayo Clinic. Avoid dairy, fatty, or spicy foods until your symptoms go away.

While people with diarrhea sometimes take probiotics, found naturally in foods like yogurt, with the aim of restoring “good” bacteria in their digestive system, medical experts don’t all agree that this strategy works, per the Mayo Clinic.

Depending on the severity of the symptoms, you may call your doctor or pharmacist to ask if you should take an antidiarrheal medication.

Home Remedies for Sore Throat May Help

While no home remedies can cure strep throat, you can do the following to feel better while the antibiotics get to work.

• Stay well-hydrated with water or cool food and fluids like smoothies, popsicles, and ice cream.
• Suck on throat lozenges, throat sprays, or hard candy.
• Sip soothing uncaffeinated teas; a little honey brings additional benefits.
• Get plenty of rest.
• Use a humidifier to add moisture to the air.
• Gargle with warm salt water to reduce throat inflammation.
• Take over-the-counter pain relievers like acetaminophen or ibuprofen.

None of these remedies should take the place of prescription medication: It’s essential to consult with a healthcare professional for guidance, because antibiotics remain the primary treatment for strep throat, says Madden.