Strep Throat(?) not reacting to Antibiotics, throat extremely swollen.

Approximately 8 days ago, I started having a sore throat. Very minor, just enough to notice, assumed it was a cold. Fast forward to Tuesday (3 days ago), I woke up with extreme discomfort in my throat, headache, stomach ache, and when I used a flashlight to look down my throat, I could see some white blotches on my tonsils. I go to the doctors, he does a rapid strep test, which did not register for strep, so he sent a throat culture to the lab. But he said it was probably strep, so he prescribed Z-pak for me, as I am allergic to Penicillin.

It has only gotten worse. While the stomach and head ache's are gone,my throat is very swollen, my uvula and tonsils have become one swollen, sore covered mass, and I cannot eat anything remotely solid. I just took the 4th set of Z-pak pills (2 pills, once a day). Doc was suppose to call yesterday with lab results, I will be calling today.

To make things even more difficult, I'm am currently transitioning between healthcare providers, and I found out on Tuesday that coverage from my first provider has already ceased, and the new one does not start until August 1st. I'm almost hesitant to go in again, and get hit with a huge bill if it is something worse.

Any ideas?

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Hec
9 Answers
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So the doc didn't have any culture results for you? I'm glad he prescribed the clindamycin; we both are thinking along the same lines. If it is EBV or CMV viral infection it can be super-infected, where the primary infection is the mono, but bacteria are taking advantage of the weakened immune system and causing a secondary infection at the same location. It is true that fatigue/malaise goes hand in hand with mono, but everyone is different and maybe you just don't get tired? Yes, if it does get worse, a CT Scan is required because if it gets to the point where your airways is completely closed, we got big problems. Keep us updated on your progress! Hope it improves fast...

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It very well can be bacterial, but most bacterial infections actually cause higher fevers than viral infections. Viral infections typically cause a low grade fever if any; bacterial endotoxins "reset" the "thermometer" in our hypothalamus that regulates our temp, causing us to have high fevers during bacterial infections. Also, azithromycin is no slouch; it's pretty good stuff and there's not much with upper respiratory illnesses that it can't take on bug wise, especially those that cause your symptoms, so the fact that you say it hasn't improved, but gotten slightly worse is concerning and makes me think viral unless you have a resistant strain of staph/strep, which then again you got to go back and get new antibiotics from your doc. But definitely follow up with your doc regarding the cultures! 3 days is the typical lab turn around time and it should be done by now. Good luck!

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There isn't much additional advice I can give you. Your doctor has followed a very standardized protocol. The fact that the azithromycin is not working for you indicates that the infection may be more viral in nature. During my peds rotation it was extremely difficult to tell what was Strep and what was mononucleosis (usually caused by EBV or CMV- both viruses) cause the presentation can be very similar. What are your demographics? If you are between 16-25 yo the chances of it being mono is much higher than it being strep throat. Both mono and strep can have those white blotches (exudates) and both present very similarly. Do you have any abdominal tenderness especially in the left upper quadrant? I highly recommend you to avoid contact sports for at least 2-3 wks or until your doc lets you know what he thinks. People infected with mono have splenomegally (enlarged spleen) and are prone to splenic ruptures if even a little rough with their body.

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Thought I would provide an update, I just got home from the Doctor, he was surprised that the Z-pac did not work. Did a blood draw for mono test, although he said I should be much more tired/drained if I had mono. Prescribed Prednisone for the swelling, and Clindamycin. Also told me if the swelling in the throat gets any worse, I need to get a CAT scan, to check for abscesses. Which would be pretty terrible without healthcare. Hopefully this holds me over till August 1st.

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I am a 23 year old male. The doctor did say it could be Mono, but I do no have abdominal tenderness, nor body pain, and I'm not tired and sore, which he said are all the symptoms of mono. Its all just my throat/neck. I can barely sleep because I wake up choking on dried/chunky flem and mucus, because my throat is so small.

My completely non-medical research was making me think it was bacterial, rather than viral, because I do not have a fever, im not throwing up, but I do have swollen lymph nodes, and my uvula is very swollen, it looks like it is just a road between my tonsils now.

Thanks!

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Thanks so much!

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The throat culture came back negative for Strep, forgot to include that.

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Also, my lymph nodes on my neck are pretty swollen

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