Misuse of Antibiotics for Sore Throat

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

Sore throat is the second-most common symptomatic reason for seeking medical care, with cough being the most common. Approximately 76% of adults who visit a primary care physician because of a sore throat are given an antibiotic, even though viruses that are not affected by antibiotics are the primary cause for upper-respiratory-tract infections. The only common cause of a sore throat that can be managed with antibiotics is the bacterial group A beta-hemolytic streptococci (GABHS), which is present in throat cultures in only 5-17% of adults. In this study, the authors examined data from 355,354 patient visits in the National Ambulatory Medical Care Survey (NAMCS) from 1989 to 1999, which resulted in a sample of 2,244 patient visits for sore throat. They calculated rates of prescriptions for patients with sore throats, as well as the different antibiotics prescribed by physicians. The results showed that when antibiotics were prescribed, they were frequently unnecessary, and often the patients were given unrecommended antibiotics. The recommended antibiotics were only prescribed in 23% of visits. Recommended antibiotic use also decreased from 32% of cases in 1989 to 11% in 1999, while unrecommended antibiotic prescriptions increased. There are two main concerns for the overuse of antibiotics, according to the authors: monetary costs and the development of strains of bacteria that are resistant to antibiotics. They conclude, "Efforts should be continued to encourage appropriate antibiotic use by both patients and physicians." -- Thanks to Chiropractic Research Review for the use of this commentary!

FROM: Antibiotic Treatment of Adults with Sore Throat by
Community Primary Care Physicians:
A National Survey, 1989-1999

Linder JA, Stafford RS
Journal of the American Medical Association 2001 (Sep 12);   286 (10):   1181–1186

General Medicine Division,
Massachusetts General Hospital,
50 Staniford St, 9th Floor, Boston, MA 02114, USA.
jlinder@partners.org

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CONTEXT:   Most sore throats are due to viral upper respiratory tract infections. Group A beta-hemolytic streptococci (GABHS), the only common cause of sore throat warranting antibiotics, is cultured in 5% to 17% of adults with sore throat. The frequency of antibiotic use for pharyngitis has greatly exceeded the prevalence of GABHS, but less is known about specific classes of antibiotics used. Only penicillin and erythromycin are recommended as first-line antibiotics against GABHS.

OBJECTIVES:   To measure trends in antibiotic use for adults with sore throat and to determine predictors of antibiotic use and nonrecommended antibiotic use.

DESIGN, SETTING, AND SUBJECTS:   Retrospective analysis of 2244 visits to primary care physicians in office-based practices in the National Ambulatory Medical Care Survey, 1989-1999, by adults with a chief complaint of sore throat.

MAIN OUTCOME MEASURES:   Treatment with antibiotics and treatment with nonrecommended antibiotics, extrapolated to US annual national rates.

RESULTS:   There were an estimated 6.7 million annual visits in the United States by adults with sore throat between 1989 and 1999. Antibiotics were used in 73% of visits (95% confidence interval [CI], 70%-76%). Patients treated with antibiotics were given nonrecommended antibiotics in 68% (95% CI, 64%-72%) of visits. From 1989 to 1999, there was a significant decrease in use of penicillin and erythromycin and an increase in use of nonrecommended antibiotics, especially extended-spectrum macrolides and extended-spectrum fluoroquinolones (P<.001 for all trends). In multivariable modeling, increasing patient age (odds ratio [OR], 0.86 per decade; 95% CI, 0.79-0.94) and general practice specialty (OR, 1.54 compared with family practice specialty; 95% CI, 1.10-2.14) were independent predictors of antibiotic use. Among patients receiving antibiotics, nonrecommended antibiotic use became more frequent over time (OR, 1.17 per year; 95% CI, 1.11-1.24).

CONCLUSIONS:   More than half of adults are treated with antibiotics for sore throat by community primary care physicians. Use of nonrecommended, more expensive, broader-spectrum antibiotics is frequent.

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