Steaming glass cup of honey lemon tea with honey dipper and lemon slice

Help, I have a sore throat! Is it Strep? Understanding pharyngitis

On February 22, 2012August 29, 2026 By Dr. Scott RennieIn Eyes, Ears, Nose & Throat1 Comment

Sore throat is one of the most common problems that people have in the winter when they come to the medical clinic. There are many different causes of a sore throat, including bacterial or viral infections. Although a sore throat usually resolves without any complications, there are times that antibiotic treatment is required. There are very rare causes of sore throat pain that can be serious or life threatening.

When to call the doctor: Since it’s tough to know your sore throat is caused by a virus or bacteria, I encourage you to call your doctor if one or more of the following are present: temperature > 101 degrees F or 38 degrees C, season is late fall, winter or early spring, you don’t have a cough, the age of the patient is between 5-15 years old, recent exposure to someone with strep throat, difficulty breathing/swallowing, your voice sounds muffled, they have a stiff neck or difficulty opening their mouth.

Causes of sore throat: Viruses are the most common cause of sore throat, but bacteria are another common cause. The causes of sore throat depend on the age of the patient as well as the season and geographic location. Many different viruses can cause swelling and throat pain. Most common viruses that cause sore throat also cause the common cold, but others include influenza, adenovirus, and Epstein-Barr virus (the cause of mononucleosis).

Symptoms of viral pharyngitis: Usually with a viral infection, the patient will have runny nose, nasal congestion and can even have irritation and/or redness of the eyes, cough, hoarseness, skin rash and even diarrhea. Viral infections can also cause fever that makes you feel miserable. A high fever does not mean that your you have a bacterial infection.

Group A streptococcus – (GAS): The bacteria that causes strep throat. Other bacteria can also cause sore throat, but group a strep is the most common. Up to 30% of children with sore throat will have strep throat. Winter and early spring are the most common times of the year when it occurs. It is the most common in school-age children and their young siblings.

Symptoms of Strep Throat: Sudden development of fever (temperature > 100.4 degrees F), headache, abdominal pain, nausea and vomiting, swollen glands in the neck, white patches of pus in the back or sides of throat, small red spots on the roof of the mouth. A cough and cold are not usually seen with strep throat.

Diagnosis: Most of the time the cause of the sore throat is a virus and does not require treatment with antibiotics. It is, however important to recognize and treat kids with strep throat to prevent complications of strep throat which can cause rheumatic fever. There are two types of tests that can help diagnose strep throat. One is a rapid strep test and the other is a throat culture. Both of these tests require a swab of the back of the throat to look for the strep bacteria. The throat culture is more accurate, but it takes 24-48 hours to get the results back. The rapid test isn’t quite as accurate but the benefit is that you know the results before going home from the clinic.

Treatment: The treatment of sore throat depends on the cause; strep throat is treated with antibiotic while viral pharyngitis is treated with rest, pain relievers and measure to make the patient more comfortable while the body heals. It is important to monitor for dehydration because some children with sore throat are reluctant to drink or eat due to pain.

Strep throat is usually treated with an antibiotic such as penicillin or similar antibiotic. After 24 hours of treatment, children can return to school most of the time. If they are having trouble swallowing or eating, they should not go to school and should be re-evaluated. The antibiotic is usually continued for a full 10 day course.

Anti-inflammatory medications such as naproxen, ibuprofen, dexamethasone or prednisone can be helpful to reduce the pain of sore throat. Oral rinses such as salt-water gargles, sprays, lozenges, and sipping warm liquids can also be helpful for sore throat pain.

Complications of strep throat: Most of the time strep throat itself isn’t dangerous. It can, however lead to serious complications such as the spread of the bacteria to the sinuses, skin, blood and middle ear. Strep throat can also lead to Scarlet fever (illness with rash), inflammation of the kidney (post-streptococcal glomerulonephritis), and even Rheumatic fever, which is a serious condition that can affect the heart, joints, nervous system and skin.

I hope that you have found this information useful. Wishing you the best of health,

Strep is one of the harder calls to make over video, since nobody can swab a throat through a camera. I went into that in the trouble with diagnosing strep throat and ear infections by telemedicine.

Updated for 2026: There Is a New Guideline, the First Since 2012
This post went up in 2012, the same year the infectious disease society last wrote formal guidance on strep throat. In October 2025 they finally revised it, so the timing here is almost comic. Here is what is different. The headline change is that scoring is now formally part of deciding who gets tested. Centor, McIsaac, or FeverPAIN, in adults and in children three and up. Before, scoring was something many of us used out of habit and clinical sense. Now it is written down (1). Worth being honest about the strength of that: the recommendation is conditional and the certainty of evidence behind it is rated very low. It is a sensible way to organize thinking, not a law of nature. The four things the score is asking about have not changed. Fever. Tonsillar swelling or exudate. Tender, swollen nodes in the front of the neck. And absence of cough, which is the one people forget and the one that carries a lot of weight. A cough pushes the odds toward a virus, hard.
Treatment Has Barely Moved, and That Is Remarkable
Group A strep has never developed penicillin resistance. Not once, not anywhere, in seventy odd years of use. Penicillin V for ten days, amoxicillin for ten days, or a single intramuscular shot of benzathine penicillin remain the answer (1). The ten days matters and it is where treatment quietly fails. You will feel better in two or three days. The course is not about how you feel, it is about preventing rheumatic fever, and stopping early is the common reason that protection is lost. If you carry a penicillin allergy label, cephalexin or cefadroxil are reasonable, but not if your reaction was the immediate kind, hives, swelling, wheeze, within minutes to hours. Macrolides and clindamycin are the fallbacks, with the caveat that resistance to both is real and varies a great deal by region (1). This is also the point where I would send you to read about getting a penicillin allergy label removed, because most of them are wrong, and this is exactly the situation where carrying a wrong one costs you the best drug.
Testing Got Better
The rapid antigen test you are used to runs around 86 percent sensitivity and 96 percent specificity. The newer molecular point of care tests come in between 93 and 99 percent sensitive (2). Practically: a positive rapid test is trustworthy, and a negative one in someone who really looks like strep is worth a second thought.
The Honest Limit of a Video Visit
I want to be straightforward, because this is the condition where patients are most often frustrated with me. I cannot swab your throat through a camera. I also cannot feel your neck. Two of the scoring elements are things I am partly taking your word for or judging from a photograph, which is not the same as an exam. What that means in practice is that I can tell you whether you are likely enough to have strep to be worth testing, and I can sort out the large group who clearly have a virus and need nothing. What I cannot do is confirm strep from here. If your score is high, you need a swab, and that means going somewhere. What helps me most is a well lit photo of the back of your throat, taken with a phone flash and a spoon handle, and a straight answer about whether you have a cough.
When It Is Not Strep and Not Minor
Some throat problems are emergencies and they announce themselves. Drooling, or being unable to swallow your own saliva. Noisy breathing. Being unable to open your mouth fully. A voice that sounds like you are talking around a hot potato. Swelling clearly worse on one side, pushing things across. A stiff neck. Any of those, stop reading and go be seen. Those patterns suggest a peritonsillar abscess, epiglottitis, or worse, and none of them get better with a prescription sent to a pharmacy.
The Bottom Line
No cough plus fever plus swollen glands plus pus on the tonsils is worth a swab. Cough and a runny nose almost never is. If you are treated, finish all ten days even though you will feel fine by day three.
Related Reading
Am I Truly Allergic to Penicillin? When to Use Telemedicine vs. Urgent Care: How I Spot the Sick One Mononucleosis – The Kissing Disease What Is a Viral Upper Respiratory Infection (URI)? I hear it almost every day now. “I think I just need a Z-Pak.”
Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
Sources
1. Infectious Diseases Society of America. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis. Updated October 14, 2025. https://www.idsociety.org/practice-guideline/streptococcal-pharyngitis2/ 2. Management of Sore Throat: Time to Update. American Family Physician. 2024;109(4):301-302. https://www.aafp.org/pubs/afp/issues/2024/0400/editorial-sore-throat.html

Sinusitis (Sinus Infection): What You Should Know Now

On February 21, 2012August 28, 2026 By Dr. Scott RennieIn Eyes, Ears, Nose & Throat2 Comments

This is the time of year when many people are getting sick with a cold or flu and then develop nasal congestion and pressure. How do you know when you have a sinus infection? Do you need to see a doctor? This will attempt to help answer those questions. Sinusitis: Swelling of the lining of the sinuses and nose. The sinuses are the hollow areas within the facial bones that are connected to the nasal openings. The sinuses are lined with mucous membranes, similar to the inside of the nose. Symptoms: Nasal congestion, purulent discharge, dental pain, facial pain, especially if it’s worse when bending forward. Other signs include fever, fatigue, cough, ear pressure/fullness, bad breath and headache. When to get help immediately: High fever > 102.5, sudden severe pain in the face or head, double vision or difficulty seeing, confusion or difficulty thinking clearly, swelling or redness around one or both eyes, stiff neck or shortness of breath. Diagnosis: Highly predictive symptoms of a sinus infection include purulent rhinorrhea and nasal congestion with facial pressure/pain. The diagnosis is supported by the sensation of ear fullness, cough, difficulty smelling and headache. Symptoms that may suggest a bacterial sinus infection include: worsening of symptoms after initial improvement of symptoms. It is generally not possible to distinguish between viral and bacterial sinus infections in the first 10 days of illness even based on history, examination or radiology studies. Most of the time radiologic tests such as x-rays or CT/Cat scans are not indicated for acute sinus infections. These radiological tests may show sinus fluid levels in both viral and bacterial sinus infections but it cannot distinguish between the two. In general acute rhinosinusitis (ARS) is the most common type that we see in the medical clinic. It is a symptomatic inflammation of the nasal passages and paranasal sinuses lasting less than 4 weeks. There are different classifications of sinusitis that are based on the length of symptoms. 1)   Acute rhinosinusitis: symtpoms for less than 4 weeks 2)   Subacute rhinosinusitis:   symptoms for 4-12 weeks 3)   Chronic rhinosinusitis: symptoms persist greater than 12 weeks 4)   Recurrent acute rhinosinusitis: 4 or more episodes of ARS per year with resolution of symptoms in-between these episodes. A sinus infection can be either viral or bacterial. Viral sinus infections usually last 7-10 days and most sinus infections are this type. Bacterial sinus infections usually (75%) go away on their own as well, but can take a month or more. In rare cases, patients with a bacterial sinus infection can develop a complication called orbital cellulitis. It is very challenging for the doctor to determine whether a sinus infection is viral (like a common cold) or bacterial. Antibiotics may be helpful for the bacterial kind of sinus infection but won’t help the viral infection. Even though about most of the sinus infections are viral, 85-98% of the patients with sinus infections in the US are prescribed an antibiotic when seen in the clinic. Acute bacterial infection occurs in only 0.5 to 2.0 percent of patients with sinus infections and virus is causing the symptoms 98-99.5% of the time. How do you get a sinus infection? Viral sinusitis begins with direct contact of the virus into the eyes or nasal mucosa by respiratory droplets from someone else. Symptoms usually develop within the next day after exposure from someone else. Bacterial sinus infections occur when bacteria secondarily infect the inflamed sinus cavity. Most of the time this is a complication of a viral sinus infection but can also be a complication from with allergies, mechanical obstruction of the nose, swimming, intranasal cocaine use, impaired mucociliary clearance due to cystic fibrosis, or immunodeficiency. You are more likely to develop a sinus infection if you smoke or you already have an impaired respiratory tract such as in cystic fibrosis. Treatment: Since viral sinus infections usually resolve within 10 days, most of the time we use medications to treat symptoms with these symptoms without the use of antibiotics. An exception would be in the case of a patient who is getting worse after initial improvement or patients with severe symptoms are who are clearly worsening or are immunocompromised. For viral sinusitis, treatment aims to relieve the symptoms of nasal pressure/obstruction and runny nose. The medications do not shorten the duration of the illness in viral infections. Options for treatment include: 1)   Analgesics such as ibuprofen, naproxen or Tylenol 2)   Topical steroid nasal spray such as Flonase, Rhinocort or Nasonex 3)   Oral decongestant such as Sudafed or anti-inflammatory medication such as prednisone 4)   Antihistamines such as Benadryl, Zyrtec, Allegra or Claritin 5)   Zinc preparations have been used, but if sprayed in the nose they way cause difficulty with smell are not recommended. 6)   Nasal saline rinses Treatment of bacterial sinus infections may include antibiotics, however 40-60% of patients with bacterial sinus infections will clear their infection without antibiotics. Antibiotics: Studies have shown nearly identical results in adults with the use of amoxicillin, Bactrim or erythromycin compared to other antibiotics. Most of the time we use Amoxicillin, either 875mg twice a day or 500mg three times a day for 10-14 days. If someone has an allergy to penicillin, Bactrim, doxycycline or other antibiotics might be chosen. There are some strains of S. pneumonia bacteria that are becoming resistant to amoxicillin. I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

The Doctor Says You Have Bronchitis: Is That Really Bad?

On February 20, 2012August 28, 2026 By Dr. Scott RennieIn RespiratoryLeave a comment

Patients frequently come into the clinic with bronchitis, especially during the winter months. Often, they are not sure what bronchitis is or how to treat it. Here is some information about bronchitis and how it is treated that will hopefully answer some of these questions. Bronchitis: Inflammation/swelling of the bronchi (large tubes that carry air to the lungs). There are two types of bronchitis. The first type is acute (sudden onset) which is the most common reason for patients to come to the clinic and the second type is chronic (long-standing). Acute bronchitis occurs with a viral infection such as a common cold – sometimes called a “chest cold.” When to see a medical provider: Fever (temperature greater than 100.4 degrees F or 38 degrees C), cough that lasts greater than 10 days, chest pain with coughing, difficulty breathing, or coughing up blood, a barking cough that makes it hard to speak, cough accompanied by unexplained weight loss. Symptoms of acute bronchitis: The most common symptom of acute bronchitis is a nagging cough. Some people cough up mucus that may be clear, yellow or green. Fever is uncommon. Chest discomfort, fatigue, and wheezing can be present. Even after acute bronchitis has cleared, you may have a dry, nagging cough that lingers for several weeks. Causes of acute bronchitis: The most common cause is a viral infection of the upper airway. Less likely, it can also be caused from a bacteria called Bordetella pertussis which causes “whooping cough.” Treatment of acute bronchitis: Relieve the symptoms of sore throat and congestion. Antibiotics do not help acute bronchitis caused by a virus. Antiviral agents are useful in some cases when the cause is influenza. Do not smoke, drink plenty of fluids and rest. Symptoms usually go away within 7 to 10 days if you do not have a underlying lung disorder. A dry, hacking cough can linger for a number of months however. Although no specific treatment exists – there are several available options to reduce symptoms: 1)   Non-steroidal anti-inflammatory medication such as ibuprofen or naproxen 2)   Heated, humidified air can help improve symptoms of nasal congestion and cough 3)   Cough suppressant medications have not shown to be helpful for most patients 4)   Inhaler medications, commonly used for patients with asthma can sometimes be helpful to reduce bronchospasm/wheezing. Complications: Pneumonia can develop from either acute or chronic bronchitis. Prevention: Do not smoke, get a yearly flu vaccine and a pneumonia vaccination as directed by your doctor, reduce exposure to air pollution, wash your hands (and your children’s hands) frequently. Chronic bronchitis: A cough that occurs on most days of the month for at least three months of the year during 2 consecutive years. Preventing the spread to others: Hand washing is very important. Alcohol-based rubs are a good alternative if no sink is available. Use a tissue to cover your mouth hen sneezing or coughing and promptly throw away the tissue immediately. I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

UTI (Bladder Infection): Common Questions Answered

On February 18, 2012August 29, 2026 By Dr. Scott RennieIn Other Diseases and ConditionsLeave a comment

Patients often come into the urgent care after trying to treat themselves at home for a urinary tract infection (UTI). Determining if you are having the symptoms of a UTI yourself at home can be confusing and quite challenging. If the wrong decision is made, and you are not treated appropriately and within the correct time period, complications can result such as progression of the UTI to kidney infection (pyelonephritis) and even to urosepsis which is when bacteria can enter your bloodstream and cause you to become very sick. Bladder infection (also known as cystitis, or UTI) is inflammation of the bladder. They are common in women, but are very rare in men. About 20% of all women get at least one bladder infection at some point in their lives. A man’s chances of getting a UTI increases as he ages due to an increase in prostate size. In elderly patients, bladder infections can be particularly difficult to diagnose. The symptoms are less specific (such as urinary incontinence or fatigue) and are frequently blamed on aging. Symptoms of bladder infection: For some patients some or all of these symptoms may be present, and for others, none of these symptoms are present and they still have a UTI. Symptoms can include urgent need to urinate on a frequent basis, painful urination, burning sensation with urinating, urinary incontinence (uncontrollable loss of urine), low back pain, pain above pubic bone, cloudy colored urine, bloody urine. Causes of bladder infection: Most are caused by a bacteria called E. coli which usually lives in the intestines. Women sometimes get bladder infections after sex. Vaginal intercourse makes it easier for bacteria to reach the bladder through the urethra. Some women contract the infection – dubbed “honeymoon cystitis” almost always after having sex. Pregnant women are also more prone to infection due to the bladder being compressed by the growing fetus. Children who get urinary tract infections should be evaluated for urinary reflux (vesicoureteral reflux or VUR). The bacteria then multiply in the bladder and cause inflammation in the walls of the bladder that may lead to the symptoms described above. In men, a UTI may be a sign of an obstruction in the urinary tract which may need investigation. Symptoms of kidney infection (aka pyelonephritis): Fever, flank pain, nausea, along with the symptoms of UTI. Vesicoureteral reflux (VUR): In normal kidney-bladder function, urine flows from the kidneys to the bladder. In children with VUR, the urine also flows backwards, from the bladder up toward the kidneys. As a result, children with CUR are at risk for kidney infections and may develop kidney damage. VUR affects about 1 percent of children. Many children will grow out of their VUR as they get older. To determine whether your child has VUR, you should ask your doctor. Testing such as kidney ultrasound other radiological tests may be ordered to evaluate for VUR. Common questions that I get asked:
I often get asked, “Will my bladder infection go away on it’s own if I drink lots of water/cranberry juice and take over the counter AZO?” The answer is probably no. As I mentioned above, there is a risk of developing a kidney infection if the bladder infection is not treated appropriately with antibiotics.
What’s the difference between over the counter AZO and Pyridium that is prescribed by your doctor? Both contain phenazopyridine, however the prescription comes in a higher strength that is more than double the concentration of the active ingredient. Can taking cranberry juice or extract cure my UTI? No. Cranberry has not been shown effective as a treatment for a documented UTI.   There is some human evidence supporting the use of cranberry juice and supplements to PREVENT a UTI, although most available studies are of such poor quality that no clear dosing guidelines are available. Can I get pregnant while taking antibiotics for a UTI? Yes, many antibiotics interfere with hormone birth control pills or medication. You should use a backup form of birth control if you are taking antibiotics. I hope that you have found this information useful. Wishing you the best of health,
Related Reading
Vaginal Dryness After Menopause: Why It Doesn’t Go Away
Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Pneumonia: Viral, Bacterial or Walking? Am I at Risk?

On February 17, 2012August 28, 2026 By Dr. Scott RennieIn RespiratoryLeave a comment

I have many patients who come to the urgent care this time of year due to cough and fever and they are worried about the possibility of pneumonia. This is a valid concern, as pneumonia is a common illness and can lead to grave disability and even death. Here are some questions they I often get asked and some information. This is for informational use – please see a physician if you are worried about the possibility of pneumonia. What is pneumonia? Community acquired pneumonia as an illness with symptoms that might be present such as cough (sometimes with mucus), fever, shaking chills, shortness of breath (may only occur when climbing stairs), and occasionally with confusion (especially in the elderly), excess sweating and clammy skin, headache, loss of appetite, low energy, and sharp or stabbing chest pain that gets worse when you breath deeply or cough. When I listen your lungs, I am listening for “crackles” which sound like scratchy sounds that sound similar to that produced by rubbing strands of hair together close to your ear. Sometimes I will order a blood test called a CBC to check white blood cell count, chest x-ray, CT scan of the chest, and even a culture of the mucus you cough up to determine if there are bacteria present. What causes pneumonia? Pneumonia can be caused by viruses or bacteria. The most common pneumonia-causing germ in adults and young kids is Streptococcus pneumonia (pneumococcus). Atypical pneumonia, often called walking pneumonia, is caused by bacteria such as Legionella pneumophila, Mycoplasma pneumonia and Chlamydophila pneumonia. Pneumocystis jiroveci pneumonia is sometimes seen in people whose immune system is not working well. Viruses are also a common cause of pneumonia, especially in infants and young children. What factors/conditions increase my chance of getting pneumonia?   Cerebral palsy, chronic lung disease (such as COPD, bronchiectasis, cystic fibrosis), cigarette smoking, difficulty swallowing (due to stroke, dementia, Parkinson’s disease, or other neurological condition), immune system problem, impaired consciousness, living in a nursing facility (such as a nursing home), other serious illnesses (such as heart disease, liver cirrhosis, or diabetes), recent surgery or trauma or recent cold, laryngitis or flu. How do you decide whether I need antibiotics and which antibiotic to use? The choice of antibiotic is often determined by multiple factors including the patients age (certain germs are found more commonly in certain age groups), findings on chest x-ray and symptoms of the patient. Chest x-ray in typical bacterial pneumonia (ie. pneumococcus or Streptococcus pneumonia usually confirms lobar involvement. In contrast, in atypical pneumonia, chest x-ray shows more diffuse involvement (source – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2795279/). If the pneumonia is caused by a virus, the antibiotic will obviously not affect the viral lung infection. What is pneumoncoccus (Streptococcus pneumonia)? In countries like the United States, pneumococcus remains the most common and important disease-causing organism in infants. Although exact numbers are difficult to obtain, it is estimated that pneumococcus infection is responsible for more than one million of the 2.6 million annual deaths due to acute respiratory infection in children younger than 5 years. Children younger than 5 years, particularly aged 2 years or younger are at an increased risk of disease. In addition, absence of breastfeeding, exposure to cigarette smoke, daycare attendance, and lack of immunization with the pneumococcal conjugate vaccine further increase the risk of disease. Adults older than 55-65 years are the next most commonly affected age group worldwide. As in the United States, the most common cause of Community Acquired Pneumonia (CAP) in Europe is S pneumoniae infection, affecting approximately 100 per 100,000 adults each year. Pneumococcus is usually treated with a medication such as penicillin/amoxicillin. What is atypical pneumonia (walking pneumonia)? Atypical pneumonia refers to pneumonia caused by certain bacteria including Legionella, Mycoplasma and Chlamydophila. Atypical pneumonia is most common in young adults and children. Pneumonia due to mycoplasma and chlamydophila bacteria is usually mild. The antibiotics used to treat atypical pneumonia include: Azithromycin, Clarithromycin, Erythromycin, Fluroquinolones and Tetracyclines. What are the most common bacteria causing pneumonia in children? That depends on the age of the child. 1)    Newborns (0 – 30 days): Group B Streptococcus, Listeria, E-Coli, Klebsiella pneumonia 2)    Young infant (1 – 3 months): S. pneumonia, S. aureus, and H. influenza 3)    Infants, toddlers and preschool-aged children: Viruses remain the most common cause for approximately 90% of all pneumonias. RSV(Respiratory Syncytial Virus) is the most common viral pathogen. 4)    School-aged children and young adolescents: Mycoplasma pneumonia is the most frequent cause among older children. 5)    Older adolescents: Mycoplasma pneumonia is the most common cause of community-acquired pneumonia during the teenage and young adult years. 6)    Immunocompromised children: Children with cystic fibrosis are especially prone to develop infections with S. aureus, P. aeruginosa, B. cepacia and other multi-drug resistant organisms. How is pneumonia spread? Most of the time the infection is carried in the upper respiratory tract of the person infected. It is spread by airborne or direct exposure to respiratory droplets from the infected person. Illness among casual contacts is infrequent. How soon after exposure do symptoms occur? The incubation period may vary, but is generally 1 to 3 days. Is there a vaccine to help prevent infections? Yes, there are two different vaccines. One primarily for adults and one for children. The vaccine for adults had been available for many years and is called Pneumovax. The pediatric vaccine is called Prevnar and is only for use in children under 5 years of age. Who should receive the adult vaccine? All adults 65 years of age or older. All persons 2 years of age or older with: chronic illness such as diabetes, heart or lung diseases, anatomic or functional asplenia, immunocompromised conditions (due to disease, cancer, chemotherapy or steroids), HIV infected individuals. Who should receive the childhood vaccine? All children less than 24 months of age. All children aged 2 to 5-6 yrs with high risk medical conditions. I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

How to Stretch Out Properly

On February 16, 2012August 29, 2026 By Dr. Scott RennieIn Orthopedic/Musculoskeletal1 Comment

I often get questions from patients about how they should warm up or prepare before starting to exercise. I have a few suggestions that I’ve learned over the years from physical therapists, personal trainers and patients who have come in from sports related injuries. A good stretching warm up raises the temperature of your muscles and promotes optimal flexibility with the goal of preventing muscle strain or spasms. 1) Understand the muscles you will be using during your particular sport. It’s important to know what your workout will involve and then stretch those muscles. For example, if you are a runner then warming up the hamstrings, quads and gluts are more important than the muscles of the upper body. 2) Begin slowly. Learn to gradually lengthen the muscles to prevent injury during exercise. You don’t need to touch your toes immediately. If fact if you over-stretch your muscles too quickly, it can put them into a spasm. 3) Hold the stretch.  Begin by holding your position once your muscles reach their limit for 10-15 seconds, then relax and perform that stretch again. Repeat on the other side of the body or extremity as necessary. 4) Once you’ve finished your workout, stretch again. You will increase your flexibility and it’s a great way to cool down after your exercise routine. 5) Don’t bounce. If you bounce when you stretch, you may increase your risk of injury and over-stretch.   You should not feel like you’re hurting yourself with stretching. If it hurts, stop the stretch immediately. Every medical professional has their favorite stretches. Some of my favorites include the following: A) Quadricep Stretches: The quadriceps are four muscles located in the anterior thigh (the Vastus lateralis, Vatus medialis, Vastus intermedius and Rectus femoris.) This muscle group acts to extend the leg while straightening the knee. Running, biking, jumping, hopping, and jogging all involve the quads and dysfunction in these muscles may lead to injury. The way I stretch this muscle group is by: 1) While standing, grab a stable structure such as the table or counter for balance with one hand. 2) Bend your knee back by grasping your ankle with the hand on the same side of your body 3) Maintain the position for 15-30 seconds and if no stretch is felt, you may bend forward at the hips, then relax to a standing position. 4) Repeat the procedure for the other leg and continue repeating for 15 minutes. B) Hamstring stretch: Your hamstring is the muscle group that runs along the back of your upper leg. Three muscles that make up the hamstrings are the biceps femoris, semimembranosus and semitendonosus. They are mostly used as a hip extensor and 1)  Place your heel on an object approximately 18″ high, and stand as erectly as possible. 2)  Extend your low back, tilting your pelvis forward, and bend forward from the hips, maintaining the curve of your low back pain. 3) For added emphasis, tilt your toes back toward you. You should feel the stretch in the back of your leg. Hold for 15-30 seconds and then repeat for the other leg for a total of 15 minutes. C) Glute Stretch: The glute muscles are defined as the buttocks. They encompass the Gluteus Maximus, gluteus medius and gluteus minimus. They play a role in movement and are used in walking, running, jumping, bicycle riding, and more. They extend and rotate the leg. 1) Lie on the floor or mat. Bend knees with feet on the floor. 2) Cross lower leg over thigh and grasp back of thigh of the lower leg with both hands 3) Pull leg toward torso and hold stretch for 15-30 seconds. Repeat for the opposite leg and continue for a total of 15 minutes. D) Calf Stretch: The calf muscles consist of the gastrocnemius and the soleus. The gastrocnemius is the big muscle at the back of the lower leg. It helps us plantar flex (point the food down). It also helps with knee extension. The Soleus muscle’s action is ankle plantar flexion. 1) Place the toes of one foot up onto the wall so that your heel is still on the ground 2) Lean forward until a stretch is felt in your calf, keeping your knee straight. 3) Hold for 15-30 seconds and then repeat with the other foot. Continue for a total of 15 minutes. I hope that you have found this information useful. Wishing you the best of health,
Related Reading
Low Back Pain: What Can Actually Help You Find Relief? Cervicalgia – A Pain in the Neck Plantar Fasciitis Explained: A Real Pain in the Foot Shoulder Pain: Common Causes and Treatment Options How to Manage Chronic Pain Without Relying on Medication
Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Sleep Tips to Help You Adjust After the Time Change

On November 5, 2011August 28, 2026 By Dr. Scott RennieIn Other Diseases and ConditionsLeave a comment

It’s that time of the year again for most of us in the United States to change our clocks back one hour to standard time (except Alaska and Arizona). For most of us means gaining an extra hour of sleep on Sunday morning. The problem is that even this one hour time change can affect our “internal clock.” The good news is however, that this time shift in the autumn is better tolerated for most, than the change in the spring. If you find that you have trouble with your sleep however, here are some hints. 1. Don’t try to force yourself to go to sleep as this can cause frustration. If you go to bed and find that you cannot fall asleep within a reasonable amount of time – say 15-30 minutes, get up out of bed and do something else until you start to fall sleepy. Then go back to the bedroom and try sleeping again. 2. Don’t read or use your computer in the bed. If you do these other non-sleep related activities in bed, your brain actually begins to associate the bed with activities other than sleep. 3. Decrease the amount of light you are exposed to an hour or so before bedtime. Melatonin, a hormone released in the brain is affected by light exposure. As the amount of light entering your eyes decreases, the level of melatonin in the brain increases and stimulates sleepiness. 4. Don’t sleep in or take naps. Get up at your normal time, even if you don’t have any obligations that you need to attend to. Establishing a sleep pattern in important, and if you sleep in or take a nap, you may find it harder to sleep later on. 5. Adjust the temperature of the room. Usually decreasing the temperature slightly at the night is helpful, because the natural circadian rhythm during sleep decreases our temperature slightly. 6. Participate in some relaxing activity before bed rather than exercising, reading an adrenaline raising story, or watching a horror film. It may seem obvious, but even watching the nightly news before going to bed can make getting to sleep more challenging. 7. Decrease the noise in your environment. Wear ear plugs if you cannot change to a location that is quiet. 8. Don’t go to bed on an empty stomach, or when your stomach is over-full. Too much fluid intake may also cause unwanted trips to the toilet. Pay special attention to caffeine, nicotine and alcohol intake which can all negatively impact sleep. Alcohol may make you feel sleepy at first, but as it wears off it may disrupt sleep later in the night. I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Superbugs CRKP, CRE and MRSA: Who Is Actually at Risk?

On April 7, 2011August 29, 2026 By Dr. Scott RennieIn Infectious DiseaseLeave a comment

CRKP is a word that fell out of use, and that tells you something

In 2011 the acronym in every headline was CRKP, carbapenem-resistant Klebsiella pneumoniae. You will barely see it now. Laboratories and public health agencies talk about CRE instead, carbapenem-resistant Enterobacterales, a family that includes Klebsiella along with E. coli, Enterobacter, Serratia and their relatives in the gut.

The rename happened because the species turned out to be the least interesting part. Resistance here rides on plasmids, small loops of DNA that one organism hands to another. A carbapenemase gene sitting in Klebsiella one week can be in E. coli the next, inside the same patient. The useful question stopped being which bug and became which gene. CDC now sorts these isolates by carbapenemase: KPC, NDM, OXA-48-like, VIM, IMP.

The World Health Organization’s 2024 Bacterial Priority Pathogens List puts carbapenem-resistant Enterobacterales in the critical category, the top tier, next to carbapenem-resistant Acinetobacter baumannii and rifampicin-resistant tuberculosis (1). MRSA sits a rung lower, in the high category (1). That is a distinction worth keeping. The organism most people have heard of ranks below the one they have not.

What the current US numbers actually say

CDC published a five-year analysis in Annals of Internal Medicine in September 2025, drawing on 29 states that require submission of carbapenem-resistant isolates, covering about 35 percent of the US population (2). Carbapenemase-producing CRE went from 2,267 cases in 2019 to 4,341 in 2023. Age-adjusted incidence up 69 percent. The subgroup driving that rise was NDM, up 461 percent across the same five years (2).

The NDM figure is the one I pay attention to. NDM stands for New Delhi metallo-beta-lactamase, and it matters because most of the newer agents built for CRE were built against KPC, the carbapenemase that used to dominate here. In CDC’s own Emerging Infections Program laboratory data, published in Emerging Infectious Diseases in May 2026, the share of carbapenemase-producing CRE isolates carrying bla_NDM climbed from 5.4 percent in 2016 to 39.8 percent in 2023 (3). By 2023, NDM was present in 27 percent of carbapenem-resistant E. coli (2).

Now the scale. Unadjusted incidence of carbapenemase-producing CRE in that 29-state cohort was 3.67 per 100,000 people in 2023 (2). Roughly four isolates per hundred thousand residents in a year.

MRSA is far more common, and its curve is flatter than the headlines suggest. Six surveillance sites counted 43,921 MRSA bloodstream infections between 2005 and 2022 (4). Incidence dropped from 32.6 per 100,000 in 2005 to 15.7 in 2016, and then the decline stopped and reversed upward through 2019, before the pandemic (4). Worldwide, deaths directly attributable to MRSA rose from 57,200 in 1990 to 130,000 in 2021 (5).

If you are reading this at home and feeling fine

Here is what the 2011 coverage never gave you. CRE is a healthcare organism. In CDC population-based surveillance across eight US sites, 1,499 CRE cases were identified and only 149 of them, 10 percent, occurred in someone with no healthcare risk factor at all (6). Overall CRE incidence in that surveillance was 2.96 per 100,000 per year. For the community-associated cases it was 0.29 (6). Of those community cases, 98 percent came from urine cultures (6).

MRSA bacteremia has the same shape. Of those 43,921 bloodstream infections, 62.3 percent were healthcare-associated community-onset, meaning the person was not an inpatient when the culture was drawn but had dialysis, recent surgery, a catheter or a recent admission behind them. Another 18.7 percent started in the hospital. That leaves 18.2 percent with no healthcare link (4), and the group driving the rise in that last category before 2020 was people who inject drugs (4).

The median age of a CRE patient in Tennessee’s 2016 to 2022 surveillance was 69.5 years (7).

So if you have not been hospitalized, have no indwelling device, are not on dialysis, do not live in a long-term care facility and have not been through repeated courses of broad-spectrum antibiotics, your CRE risk sits near that 0.29 per 100,000. I am going to say that without hedging, because hedging it does you no favors. The people who genuinely need to worry about CRE mostly already know they are seriously ill.

The boil you had is a different problem

You may have had a hot red lump that got drained and cultured out as MRSA. That is community-associated MRSA skin infection, and it is a separate clinical animal from the resistant gram-negatives that make the news.

The May 2026 American Family Physician review on skin and soft tissue infections lands where practice has sat for years. Drainage is the treatment. Antibiotics after drainage lower the chance of failure and recurrence, and do not substitute for the procedure (8). Trimethoprim-sulfamethoxazole or clindamycin covers community MRSA (8). One detail worth having if anyone offers you a nasal swab: a negative nasal MRSA PCR does not rule out MRSA as the cause of a cellulitis or an abscess (8).

I send a suspected abscess out for drainage right away rather than treating it empirically and waiting. Drainage is what cures an abscess, and an antibiotic on its own is neither necessary nor sufficient.

Having had a MRSA boil does not put you on a path toward CRE. Different organism, different reservoir.

For clinicians, the report line is no longer the answer

Two things should change what you do.

The word CRE on a micro report has stopped being sufficient. Treatment now depends on carbapenemase class, and the CDC authors say so plainly: carbapenemase testing is limited in clinical laboratories, public health laboratory results often arrive too late for the decision in front of you, and susceptibility testing for aztreonam-avibactam and cefiderocol, the only beta-lactam-based agents active against NDM, is not widely available (2). A ceftazidime-avibactam reflex that was defensible in a KPC-dominant era will fail against an NDM producer. Learn your local carbapenemase mix.

Admission risk prediction also works better than most of us assume. A model validated in 2025 against Atlanta public health data and then replicated inside an academic health system identified patients at high risk of carrying CRE on admission using age, prior infection diagnosis, and the number and mean length of acute care hospitalizations in the preceding year, reaching an area under the curve of 0.85 in the public health dataset; adding Elixhauser comorbidity score, antibiotic days of therapy in the prior year, diabetes and prior ICU admission improved performance within the health system (9). Antibiotic days in the prior year is the variable you can actually move.

The outcomes justify the attention. In Tennessee surveillance, carbapenemase-producing CRE carried more than double the odds of death at 90 days compared with non-carbapenemase-producing CRE (odds ratio 2.22, 95 percent CI 1.12 to 4.42) (7).

I do not routinely ask about hospitalization outside the United States when someone reports recurrent urinary tract infections. That is a description of my practice, not a defense of it. The NDM figures above, and the travel and foreign-healthcare exposure that sits behind much of that risk, are printed a few paragraphs from that sentence, and a reader who notices the gap between the two is reading correctly.

The Bottom Line

CRKP became CRE because the resistance gene travels between species and now matters more than the name of the organism carrying it. Carbapenemase-producing CRE is rising here, 69 percent higher in age-adjusted incidence from 2019 to 2023, with NDM up 461 percent (2). At 3.67 cases per 100,000 it stays uncommon, and it stays concentrated. Ninety percent of CRE cases in CDC surveillance had a healthcare risk factor (6). About 81 percent of MRSA bloodstream infections were hospital-onset or healthcare-associated (4).

If you are healthy, out of the hospital and free of devices, these organisms are a public health problem you should want funded, not a personal threat that should cost you sleep. If you are on dialysis, living in long-term care, carrying a central line, or coming off months of broad-spectrum antibiotics, the math is different. The conversation to have with your physician then is about lines and antibiotic exposure, not about hand sanitizer.

Related Reading
Why Won’t Antibiotics Cure a Viral Infection? Doctor Explains Antibiotic Resistance Could End Modern Medicine, WHO Warns I hear it almost every day now. “I think I just need a Z-Pak.” Abscesses – What to do about MRSA (Methicillin-resistant Staphylococcus aureus)
Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Sources

1. World Health Organization. WHO updates list of drug-resistant bacteria most threatening to human health. 17 May 2024. https://www.who.int/news/item/17-05-2024-who-updates-list-of-drug-resistant-bacteria-most-threatening-to-human-health and WHO bacterial priority pathogens list, 2024. https://www.who.int/publications/i/item/9789240093461

2. Rankin DA, Stahl A, Sabour S, Khan MA, Armstrong T, Huang JY, Baggs J, Spalding Walters M. Changes in Carbapenemase-Producing Carbapenem-Resistant Enterobacterales, 2019-2023. Ann Intern Med. 2025 Sep 23;178(12):1818-1821. https://pmc.ncbi.nlm.nih.gov/articles/PMC12645407/

3. Increase in bla_NDM among Carbapenemase-Producing, Carbapenem-Resistant Enterobacterales, United States, 2016-2023. Emerg Infect Dis. 2026 Jun;32(6). Published online 27 May 2026. https://wwwnc.cdc.gov/eid/article/32/6/25-1404_article

4. Biggs HM, Li R, Jackson KA, Nadle J, Petit S, Ray SM, Lynfield R, Como-Sabetti K, Dumyati G, Gellert A, Walsh M, Schaffner W, Baggs J, See I. Trends in Incidence and Epidemiology of Methicillin-Resistant Staphylococcus aureus Bacteremia, Six Emerging Infections Program Surveillance Sites, 2005-2022. Open Forum Infect Dis. 2025;12(6):ofaf282. https://pmc.ncbi.nlm.nih.gov/articles/PMC12125674/

5. GBD 2021 Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050. Lancet. 2024;404(10459):1199-1226. https://pubmed.ncbi.nlm.nih.gov/39299261/

6. Bulens SN, Reses HE, Ansari UA, et al. Carbapenem-resistant Enterobacterales in individuals with and without health care risk factors, Emerging Infections Program, United States, 2012-2015. Am J Infect Control. 2023 Jan;51(1):70-77. https://pmc.ncbi.nlm.nih.gov/articles/PMC10881240/

7. Muleta D, Nouer SS, Tolley EA, Villegas RM, Taylor J, Harriott MM. Epidemiology of carbapenem-resistant Enterobacterales infections in Tennessee, 2016-2022. Epidemiol Infect. 2025 Sep 8;153:e119. https://pmc.ncbi.nlm.nih.gov/articles/PMC12529416/

8. Chambliss ML, Rumball A, Brown CM. Skin and Soft Tissue Infections. Am Fam Physician. May 2026. https://www.aafp.org/afp/2026/0500/skin-soft-tissue-infections

9. Prakash-Asrani R, Bower C, Robichaux C, Chan B, Jacob JT, Fridkin SK, Howard-Anderson J. Identifying patients at high risk for carbapenem-resistant Enterobacterales (CRE) carriage on admission to acute care hospitals: validating and expanding on a public health model. Infect Control Hosp Epidemiol. 2025 Apr;46(4):398-403. https://pmc.ncbi.nlm.nih.gov/articles/PMC12015620/

Tips to Manage and Organize Your Elderly Parent’s Medications

On April 7, 2011August 28, 2026 By Dr. Scott RennieIn Senior & Caregiver HealthLeave a comment

Many of my patients, and many of the families I work with, face the same challenge. Their parents are taking multiple medications, sometimes several times a day, and it’s hard to keep everything straight. As memory declines with age, the details of what to take, when to take it, and why it matters can easily get lost. The problem is that missing doses or mixing up prescriptions can quickly affect health.

I’ve found that patients do better when they understand why they’re taking each medication. A simple note like “blood pressure” or “cholesterol” written next to the name helps. I often hand out an updated medication list at every visit. It’s printed in a large, easy-to-read font so it doesn’t get overlooked. Some people keep that list on the fridge or next to their pill bottles so they can check it quickly. Others like to carry it on a USB drive or keep it stored securely online, so it’s available if they land in another clinic or hospital. The key is making sure the list stays current. Whenever a prescription changes, I encourage families to replace the old list immediately (Centers for Disease Control and Prevention, 2023).

Where medications are stored makes a difference too. If bottles are tucked away in a cabinet, they’re easier to forget. Putting them near the coffee maker, a water dispenser, or a bathroom sink works better. Those spots become natural reminders because the person passes them throughout the day.

When I visit a patient at home, I try to look at the actual bottles. Comparing what’s on the label with what’s on the chart can prevent mistakes, like taking an outdated prescription. If a refill is almost due, it’s easier to take care of it right then than to wait until the patient runs out.

Simple tools can also make a big impact. Pill boxes are inexpensive and work well for organizing doses by day or time. Even basic versions you can buy at the pharmacy help patients and caregivers see at a glance whether a dose has been taken. More advanced boxes come with reminders built in, though those cost more.

Technology is playing a growing role in this space. Some prescription bottles now come with reminder caps that glow, beep, or even send a text message when it’s time to take the next dose. Vitality’s GlowCaps are one example that combine light and sound alerts with electronic reminders (Vitality, 2024). For patients who already use smartphones, setting a daily alarm or calendar alert works just as well.

There are also mobile apps designed specifically for tracking medications. Options like iPills, Pillbox, Pillboxer, and The Pill Phone help patients and caregivers schedule, track, and confirm doses (National Institutes of Health, 2022). For tech-savvy patients, these can reduce the burden of trying to remember everything on their own.

None of these approaches are complicated, but they do take a little extra time and attention. Whether it’s keeping an updated list, moving the bottles where they’re easier to see, or using a pill box or phone alarm, the goal is the same. Patients who remember their medications stay healthier, and caregivers have one less thing to worry about.

This article is for information only and is not medical advice for any individual. Please talk with your medical provider about any specific questions.

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

End-of-Life Care: How to Talk About Your Own Wishes

On April 6, 2011August 29, 2026 By Dr. Scott RennieIn Senior & Caregiver HealthLeave a comment

Last week I sat with a patient who wanted to talk about end of life care. They weren’t sure how to bring it up with their family. That’s something I see often. These conversations are difficult, and many families don’t know what their loved one would want until a crisis forces the issue.

In medicine, we routinely ask elderly or terminally ill patients about their preferences if their heart were to stop or they couldn’t breathe. For younger patients the assumption is clear. Everything will be done. That usually means putting in a breathing tube, doing CPR, and starting medications through an IV. But for someone at the end of their life, those same measures may not be what they want. Some even feel those interventions would add suffering rather than comfort. What many people don’t realize is that unless there’s a written order stating otherwise, hospitals are required to attempt resuscitation (American Hospital Association, 2008).

Families often find it easier to honor those wishes if they’ve already been discussed. I’ve seen the opposite too. Relatives gathered at the bedside, each with a different opinion, unsure of what the patient would have chosen. When these conversations happen in advance, patients get peace of mind and families can act with confidence.

Many hospitals offer worksheets to help guide these decisions. They can be filled out ahead of time and kept in an accessible place, like on the refrigerator. That way, if emergency responders arrive, the document is easy to find. State-specific advance directives were available as early as 2011 through the National Hospice and Palliative Care Organization, and those forms allowed patients to record their choices and designate someone to speak for them if they could not (NHPCO, 2011).

These conversations are never simple, but they make a difference. They help ensure care matches what the patient truly wants and reduce the stress on families in the middle of a crisis.

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Sources (pre-2011):

American Hospital Association. “Patient Self-Determination Act and Advance Directives.” AHA, 2008.

National Hospice and Palliative Care Organization. “Advance Directives.” NHPCO, 2011.

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