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Most antibiotics prescribed for sore throat unneeded

By Genevra Pittman

NEW YORK (Reuters Health) - Most Americans with a sore throat are prescribed antibiotics even though just a fraction stand to benefit from them, a new study shows.

Researchers said only about 10 percent of adults with sore throats have strep throat, which is caused by bacteria that could be killed by antibiotics.

Almost all other sore throats are caused by viruses. In those cases, "an antibiotic is not going to help you and it has a very real chance of hurting you," Dr. Jeffrey Linder, who worked on the study at Brigham and Women's Hospital in Boston, said.

Although serious side effects are rare, he said antibiotics can cause diarrhea or yeast infections and interact with other medicines. Overuse of the drugs also makes bacteria resistant to them - which means future infections could be harder to treat.

For their study, Linder and his colleague Dr. Michael Barnett analyzed data on 8,200 U.S. primary care and emergency room visits for sore throats between 1997 and 2010.

They found doctors prescribed an antibiotic at 60 percent of those visits, with no change in that rate during the study period, according to findings published in JAMA Internal Medicine.

What did change is that a greater proportion of prescriptions were for new, expensive antibiotics in recent years - even though penicillin works just fine against strep throat, Linder told Reuters Health.

His team's findings were presented Thursday at IDWeek 2013 in San Francisco.

The researchers noted that they didn't have data on each patient's diagnosis, so they couldn't know exactly when antibiotics were appropriate.

Linder said ideally, doctors should use a few key symptoms to figure out which patients should be tested for strep throat. Patients are more likely to have strep if they have a fever, swollen lymph nodes, white spots on the tonsils or swollen tonsils and no cough.

But the test is often used "pretty indiscriminately," or people are given antibiotics without even being tested for strep, Linder said.

Dr. Ralph Gonzales, who has studied antibiotic prescribing at the University of California, San Francisco, said the results weren't all bad news, necessarily.

The proportion of people visiting their primary care doctor for a sore throat - rather than any other complaint - dropped from almost 8 percent to about 4 percent during the study period, he noted.

He said fewer total visits for sore throats means fewer antibiotics are being prescribed - even if most people with achy throats still get the drugs.

"At least from a public health perspective, we're having a lower impact on resistance," Gonzales, who wasn't involved in the new research, told Reuters Health.

Dr. Paul Little, a professor of primary care research at the University of Southampton in the UK, said people can avoid getting unneeded antibiotics by not going to the doctor for a run-of-the-mill sore throat.

"The truth is, nasty things are really pretty uncommon," Little, who also didn't participate in the study, told Reuters Health. "What you need to do is manage your symptoms," he said, such as with over-the-counter pain relievers and plenty of fluids.

"The vast, vast majority of these are going to get better on their own," Linder agreed.

Still, Little said, "If you're worried about it and you're very unwell … then I think it is worth it to see a doctor and have a (strep) test."

SOURCE: http://bit.ly/KEPNSw JAMA Internal Medicine, online October 3, 2013.

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