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Herpes Pharyngitis? "Strep Throat," Mononucleosis & more.

Uploaded by: LuisLomeliMD
Video Description:
Pharyngitis has many causes. Patients with anxiety report "pharyngitis" and a dry throat (Globus Hystericus). Many patients, especially singers, "lose" their voice when stressed.
Lionel Richie (singer) "lost" his voice in the 1980's. His ENT (Ear-Nose-Throat) doctor subjected him to multiple procedures to no avail. He was "cured" by a "naturalist" or homeopathic person. Basically, he was treated with a placebo (nothing) and recovered.
I dread seeing singers that have to perform but have "lost" their voice just before performing. I would dread to treat Renée Fleming, an opera singer, for "laryngitis" because she felt that she had lost her voice just before an engagement.
In my opinion, the drug of choice for Strep Pharyngitis is Amoxicillin since 85% of it is readily absorbed. It is estimated that only 50% of an oral dose of Ampicillin is absorbed. My second choice is Cephalexin, which is inexpensive and costs about 15 cents per 500 mg capsule. If a person is allergic to Amoxicillin or Penicillin, the risk of being allergic to Cephalexin (a first generation cephalosporin) is about 10 to 12%.
I do not recommend Bicillin-LA for Strep pharyngitis because the patient is exposed to the antibiotic from 2 to 4 weeks. It may be difficult to treat a reaction if the patient develops an allergy. In addition, it provides a very low dose since 1,600 units = 1 mg. That is, a 1.2 million dose of Bicillin-LA provides a mere 750 mg total dose over 2 to 4 weeks.
I do not recommend Sulfamethoxazole/Trimethoprim (Bactrim®) or Septra®) for Strep Pharyngitis. Ask your attending physician regarding Cipro® and Levaquin® in the treatment of Strep pharyngitis.
Ketex® (a macrolide derivative) may be relatively more toxic than Erythromycin Ethyl Succinate. You should look up the current controversy regarding Ketex® (Ketolide).
If a patient is allergic to Amoxicillin and the Cephalosporins, I treat them with an IM injection of Lincocin®, a macrolide, followed by Erythromycin.
Once a patient was treated for pharyngitis when in fact he had Bacterial Meningitis (Meningococcal) with associated brain swelling, and vomiting. His vomiting and dehydration caused him to feel a "sore throat." He died after his brain herniated through the Foramen magnum. I alerted the family and advised them to immediately bring me any family member with fever and headache. A few months later, I saved his nephew from acute meningitis.
Clinical medicine is complex and intriguing.
Luis Lomeli MD

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