There was a time when most severe sore throats were treated with big doses of penicillin. That was because strep infections were not easy to diagnose and penicillin antibiotics are highly effecting for knocking out this bacterium. Then physicians realized that most sore throats are actually caused by viral infections for which antibiotics are useless. Rapid strep tests now allow pediatricians to rapidly diagnose the group A streptococcal bacterium that causes strep throat. When that is the culprit, it can be treated appropriately with antibiotics.
Now researchers are recognizing that another bacterial infection can cause severe sore throats, especially in adolescents and young adults. It is called Fusobacterium necrophorum and this bug can cause Lemierre syndrome. If not treated aggressively, this condition can be lethal in teens. Unfortunately, there is no rapid test for this bacterium. Red flags include night sweats, high fevers and swelling on one side of the neck. Lemierre’s requires treatment with high doses of penicillin and additional antimicrobial agents such as metronidazole.
[Annals of Internal Medicine, Dec. 1, 2009]