A few interesting facts about strep throat

I have compiled this in November after doing a short literature review. It is indeed quite revealing and asks a question: Why the heck do we even care about treating it?

Given antibiotics
-1 in 8 will see improvement in symptoms (for culture proven strep)
-Mean reduction of symptoms < 1 day
-No change in 1 week symptom rate compared to placebo
-No effect on school/work attendance.
-1 in 10 will see side effects from antibiotics
-Number need to treat to prevent one rheumatic fever staggering 15,000
-No effect on glomerulonephritis rate

As per quite a nice review in http://www.cfp.ca/content/57/7/791.full

What this basically means is that 1 in 8 patients receiving antibiotics for a proven strep throat will see some difference, which would in turn be about half a day less of sickness. And 1 in 10 would have a side effect. My question then becomes whether I should even try to talk about 1/15,000 reduction of rheumatic fever, or whether that just confuses people more. Or is 1/15,000 close enough to nil-value that I should basically say antibiotics do not change the rate of any rheumatic complications whether rheumatic fever or glomerulonephritis?

Other interesting findings against giving antibiotics.

-Antibiotics prescription seems to increase recurrence of strep. (as per Up To Date)

-Amoxicillin should be avoided with empirical therapy as some viral tonsillitis such as mono will cause rash. GAS is 100% sensitive to Pen V. (at least in around Ottawa.)