ToC created by gh-md-toc
- I dislike the side effects of antibiotics, and dislike breeding antibiotic resistance
- I will probably avoid antibiotics for non-critical ailments (as long as whatever I am sick with is self-resolving without serious complications, OTC remedies cure equally well to antibiotics, and I am not in screaming pain)
- herbal/OTC remedies are useful to know about because they are:
- comparably effective for curing many non-critical ailments
- more useful as prophylactics, as they can be safely used more frequently than pharmaceutical drugs
- even while using pharmaceutical-strength drugs, herbal/OTC drugs are useful to alleviate pain and fill in for noncritical/symptomatic relief. I like to use pharmaceuticals for critical root-cause treatment and herbal/OTCs for symptomatic treatment.
- however, I like to be well informed on risks of dangerous complications so I can pursue clinical intervention
- I like reading papers regardless of field because I'm a fuckin nerd
- Personally, I prefer to power through purely symptomatic issues without pharmaceuticals so that I can more accurately monitor my root cause prognosis and incur fewer nasty side effects, unless the symptomatic pain exceeds 8 out of 10 aka lying on the ground crying and can't walk. This is also because I'm a fuckin nerd and like my data pure
- knowledge is power! you can always ask your doctor which prescriptions are to treat your root cause, and which ones are meant for symptomatic treatment and therefore acceptable to skip if you are at a manageable pain threshold.
As a general rule, see your doctor ASAP if you are totally crippled from symptoms or have reason to believe it's a more serious complication, such as a peritonsillar abscess.
- you have a 101F fever (or subjectively, if your fever is crippling and you can barely move)
- you have trouble breathing
- you are dehydrated/malnourished due to pain from swallowing
Antibiotics are of course ineffective against viral infections, and may not always be necessary in bacterial cases. Regardless, they are still widely prescribed because they reduce contagion time from ~2 weeks to only ~24 hours after starting antibiotics, and they vastly decrease the risk of critical followup complications such as peritonsillar abscesses or rheumatic fever.
Rheumatic fever is more incident in children aged 5-15, fairly rare, but extremely life-threatening and can result in permanent internal organ damage [1].
- strep: (diagnosis) infection with group A Streptococcus bacteria
- throat culture test: lab test for strep presence that takes 1-2 days to get results
- rapid strep test: 10-minute strep test. (When using culture results as truth value, apparently has a ~25% false positive rate and ~4% false negative rate for adults, according to this study using 328 adults.)
- tonsillitis: (symptom) inflammation of the tonsils; may be viral or bacterial
Peritonsillar abscesses (PTA) are a potential followup complication from untreated strep.
High level overview citations: [2 (WikiEM)][3 (ScienceDirect)][4 (AAFP)][5 (NCBI)]
Characterized by painful swelling of an area of linked lymphoid tissue called the peritonsillar area, which includes:
- tonsils (difficulty swallowing, visibly swollen tonsil (uvula will look like it is pushed to the side))
- neck/throat (difficulty swallowing, probably excessive drool as result of difficulty swallowing saliva, possible difficulty breathing)
- ear (ear pain)
- jaw (pain while opening mouth)
The pain & inflammation will almost always present asymmetrically, along just one side of your head. Peritonsillar swelling on both sides is extremely rare and life threatening, but you'll know if you have it because your airway will be completely blocked and you should get someone to call 911 right away [6].
You may also experience fever, chills, and headache, but these are also symptomatic of just tonsillitis. The difference that tipped me off was the extreme pain and swelling corresponding exactly to the peritonsillar region.
If you are experiencing these, go to a doctor as soon as possible the same day, as it means the infection has spread beyond your tonsils and requires rapid intervention (though not 911-level rapidity).
Potentially life-threatening if untreated, due to the risk of sepsis (tonsils are 0.5cm proximal to the carotid artery), and runs the risk of other abscesses from the infection spreading to further head deep tissue areas. Also extremely painful and makes it difficult to eat or drink, so will leave you fairly dehydrated and malnourished as a bonus.
Unfortunately, I can't find statistics on incidence following untreated strep, but it may occur in 1% of cases following even antibiotic-treated strep.
(Timeline note: Literature points to these typically following several-day periods of untreated strep, but I was diagnosed with it 2.5 days after initial sore throat symptoms and had a sudden fever on the very first day. Not sure how common this is; I just have too much information on this topic because I realized that I had one while browsing pubmed. So, use your best judgment (or your doctor's).)
Antibiotics to treat the root cause, plus likely pus drainage (via aspiration or incision) and/or steroids depending on your condition.
Warning: High-dose corticosteroids are quite well-studied to trigger or exacerbate mood disorders [7] (and other side effects [8]), most commonly mania but also depression and delirium. Since steroids are only a symptomatic treatment rather than a root cause treatment, you can ask your doctor to skip these if your pain is manageable or you're worried about a history of mood disorders, although you are probably ok at one-time doses or low doses.
Continue gargling.
If you taste something persistently bad in your mouth, it might just be a side effect of one of your meds or another co-condition.
- antibiotics (penicillin family): can experience metallic taste
- corticosteroids: can experience bitter or metallic taste
- tonsil stones: foul/sulfurous odor and taste
The following assumes you did not have your abscess drained by your physician.
If the foul taste seems to transfer to liquid you swish around your mouth but goes away temporarily when you spit it out and replace it with fresh liquid, it's an exudate rather than a taste bud or perception issue. If it's a particularly foul and rotting taste that comes from the back of your mouth, the pus that has been rotting inside your tonsil just might be draining out of your abscess! If so, CONGRATULATIONS \o/
I used a sequence of the following gargles/washes to try to get the foul taste out:
- warm salt water
- apple cider vinegar diluted in warm water, enough to not sting at all (this is what made the bulk of my pus drain during multiple rounds)
- plain warm water
You can alternate the gargling with front-to-back swishing if you are getting tired. I used a very small mouthful of water and very gentle suction pressure (don't hurt yourself) combined with those mucus-hacking muscles to bring up a lot more pus.
You did it right if after the first round of pus drainage, your tonsil is less swollen and painful, your uvula has reverted to a more normal position, and you can drink liquids with less pain.
If your pus has started to drain, continue gargling every 30 minutes for the next few hours [7] (or longer if continued pus drainage keeps bothering you) plus any time after eating, to ensure that the abscess is being regularly flushed out. You will probably come up with more pus (though in smaller volumes than the first drain) as more pus continues to drain from surrounding tissue into your wondrously relieved abscess cavity.
A hot compress may also help accelerate drainage (as well as temporarily alleviate pain).
- warm salt water gargle (studies demonstrate efficacy of plain water gargles or povidone-iodine [8], I can't find ones that control for plain saline for upper respiratory tract infections for some reason, but a little osmosis doesn’t hurt)
- topical honey shots direct to the throat [9][10] (+ can add honey in everything to follow to make it more palatable)
- make a tea from honey, lemon, ginger, cloves[11][12][13]
If you get desperate/bored, these seem to be backed by data. Subjectively, they don't feel as symptomatically relieving for me as the remedies above.
-
- turmeric? (no studies using it to alleviate URTIs / tonsillitis, but it's a pretty well studied anti-inflammatory agent)
- raw garlic is a well studied antimicrobial [14][15] (chew on a whole clove if you're bold, suck on a piece, or crush it and add honey)
- echinacea/sage topical (similar efficacy to chlorhexidine/lidocaine as an antimicrobial/anesthetic for acute sore throat treatment [16]). I use it as a gargle. Subjectively, it's ok but honey is easier and feels immediately better.
- topical of essential oils on external swollen areas? lemongrass[17], lavender[18], maybe eucalyptus. (dilute 6 tsp carrier oil to 15 drops essential oil to avoid irritation; jojoba is a neutral non-comedogenic carrier)
- warm compress on external swollen areas. (can also add essential oils directly to this without a carrier)
(pain control group: warm water)
optimizing for: calorie-to-pain ratio, minimal chewing
- warm feels slightly easier than cold
- bready/grainy things feel like they get caught in the tonsils, no good
- greek yogurt is my favorite calorically efficient minimal-swallowing-pain food at ~280 cals/cup, especially if you add honey for an extra 60 cals/tbsp
- lentils (cooked very soft -- split lentils cook down faster) are also a highly calorically dense food, although they may feel like they get stuck in your swollen tonsils. cook with broth for morale flavor and extra calories.
- coconut oil is a super dense way to get quick calories
- savory: gentle curries, very well-cooked lentils, blended veg soup w/ heavy cream for extra calories, rice porridge, steamed eggs
- sweet: smoothies, dairy, ice cream (in small quantities; minimize sugar), coconut water
- morale flavors: bouillon, soy sauce, sesame oil, rich broth (pho, miso, bone broth (only 50 cals/cup))
once you can eat non-liquid foods again, you want to compensate for the damage the antibiotics will wreak on your digestive system. (diarrhea, gas, indigestion, yeast infections, etc, etc)
take a strong daily digestive probiotic claiming many billions of live organisms. this will directly replenish your healthy gut flora and yield a noticeable reduction in antibiotics-induced diarrhea. continue taking for some time after the antibiotic course is finished.
if necessary (aka you are adequately hydrating and eating but still dehydrated/malnourished because your intestines are not working), take an anti-diarrheal (such as loperamide hydrochloride).
if you are female, take a female-specific probiotic as your vaginal flora will also be wrecked by the antibiotics.
- avoid sugars
- fermented foods (kimchi, other pickles, yogurt, cheese, kombucha) will help your gut flora recover
- high fiber helps your gut bacteria, though it may slow the absorption of oral antibiotics
- avoid grapefruit during your antibiotics course -- apparently it can prevent your body from properly breaking down antibiotics
candida is a common yeast, aka not killed by antibiotics, which flourishes and is prone to overgrowth when your normal bacteria are not strong enough to fight it off. if you have a vagina you may be unfortunately familiar with the colloquial "yeast infection".
AVOID SUGAR
- particularly refined sugar, and carbs. these are its favorite foods.
- fruits, starchy vegetables, and milk sugars should be reduced due to their metabolizable sugars.
- (some amount of yogurt and honey is fine due to their other benefits.)
antifungal foods
- garlic
- ginger
- brassica vegetables (broccoli, kale, arugula, radishes, collard greens, brussels sprouts, cauliflower...)
- coconut oil
- cloves
tl;dr this all sounds pretty similar to keto
Great overview article with pubmed citations
- put on a face mask and copiously wash your hands when you're sick, don't be selfish
- regular gargling is highly efficacious for URTI prevention [19]
- throw out your old toothbrush once your contagion period ends (about a day after starting antibiotics)
- wash all the sheets and clothes you drooled and/or wiped your mouth on while sick
- you can gargle farther down in your throat if you use the same muscles that you use to hack up phlegm or mucus during the flu
- you can get liquid farther down in your throat by pretending you're going to swallow it, but bluffing at the last minute and holding it mid-throat
- lean close over a sink and have a towel handy! you might retch mid-gargle on the front of your shirt, or at least all over your chin, and that is no fun.