That doctors should nonchalantly toss drugs at millions more sore throat cases isn't what Centor is suggesting. But he wants them to pay close attention to signs that a negative strep test isn't telling the whole story. There's no rapid test for F. necrophorum—doctors have to do a special culture and tell the lab what to look for. Adolescents and young adults (ages 15 to 30) who have a sore throat that worsens on the fourth day along with fevers, shaking, and night sweats should be admitted to the hospital and treated with IV antibiotics, Centor says. Neck swelling is a particular concern; it could mean the infection has reached the large internal jugular vein. In addition, he says, doctors should not prescribe commonly used Zithromax or drugs like it (including erythromycin), which kill strep but don't touch F. necrophorum. Instead, they should use penicillin and related drugs that kill both bacteria.
Centor isn't an infectious-disease specialist and hasn't worked on any of the official panels that publish sore throat practice guidelines. ("Nobody ever invited me," he says.) So for the second time, he's trying to change the game from the sidelines: He plans to formally request that the federal Centers for Disease Control and Prevention launch an F. Necrophorum monitoring program. It will take hard numbers to prove whether Centor is prescient or merely overexcitable. But the thrust of his plea is hard to knock: We should pay closer attention to the lowly sore throat.