INFECTIONS
November 5, 2013

Most Sore Throats Don't Need Antibiotics

Your throat is sore. Sure, it's terrible; but if you're an adult, it is unlikely you need an antibiotic.

Cold and flu season is upon us and for many, a painfully sore throat is the first sign. When your throat feels like you've gargled with razor blades, you're desperate to feel better.

So you head to the doctor, assuming it is strep, and expecting that you will be given a prescription for an antibiotic to relieve your discomfort. After all, it's an infection, right? Well, that may be true, but not every sore throat merits treatment with an antibiotic.

The overprescribing of antibiotics is not only bad for our health, it's bad for healthcare costs as well.

Most people know that antibiotics have been overprescribed in the U.S. for decades, despite the efforts of the U.S. Centers for Disease Control and Prevention, among others. True, prescriptions for penicillin, the drug of choice when it comes to streptococcal infections, are down slightly. But prescriptions for newer, more expensive drugs, like azithromycin are on the rise.

Choosing An Unnecessary — And Expensive — Option

According to a new study from researchers at Brigham and Women’s Hospital (BWH) in Boston, the overprescribing of antibiotics is not only bad for our health, it's bad for healthcare costs as well.

This overuse of antibiotics is potentially dangerous. “We know that antibiotic prescribing, particularly to patients who are not likely to benefit from it, increases the prevalence of antibiotic-resistant bacteria, a growing concern both here in the United States and around the world,” Jeffrey Linder, a physician and researcher in the Division of General Medicine and Primary Care at BWH said in a statement.

The Study
Linder, senior author on the paper, and lead author Michael Barnett measured changes in the prescribing of antibiotics for adults with sore throat and acute bronchitis (coughing) between 1996 and 2010 using surveys of ambulatory care provided by U.S. primary care clinics and emergency departments. The data represented approximately 39 million clinics or emergency department visits.

Strep is far less likely in adults than it is in children.

They found that even as the percentage of visits to primary care doctors for sore throats decreased from 7.5 percent of visits in 1997 to 4.3 percent of visits in 2010, the rate at which antibiotics were prescribed did not change. Physicians prescribed antibiotics for 60 percent of patients' visits. There was also increase in the antibiotic prescribing rate in emergency rooms — from 69 percent to 73 percent, during the same 14-year period.

“Our research shows that while only 10 percent of adults with sore throat have strep, the only common cause of sore throat requiring antibiotics, the national antibiotic prescribing rate for adults with sore throat has remained at 60 percent,” Linder told TheDoctor. He also said that for acute bronchitis, the appropriate antibiotic prescribing rate should be about zero percent, yet the national antibiotic prescribing rate was 73 percent.

The data also show that the prescribing rate for penicillin, the antibiotic recommended to treat strep throat, remained at 9 percent while the rate for azithromycin, a more expensive antibiotic, increased from being too infrequent to measure reliably in1997-1998 to 15 percent of visits in 2009-2010.

The Takeaway

Strep is far less likely in adults than it is in children. In fact, 90 percent of the time, adult sore throat sufferers do not have strep throat, said Linder. The older you are, the less likely you are to have strep throat; your body has developed its immunity to the bacteria.

Linder elaborated that if you have the signs and symptoms of a viral upper respiratory infection, such as a runny nose, cough, and body aches, but you do not have a high fever, you most likely have a cold virus, not strep throat.

“If you feel the need to see your doctor for a sore throat, most of the time, you should not expect an antibiotic, and you should go into the consultation being clear that you don’t necessarily want an antibiotic but you just want to be sure that you don’t have a strep throat,” said Linder. If you have a high fever, very severe sore throat, swollen glands, or are feeling particularly sick, it's more likely that you have strep throat.

If you have the signs and symptoms of a viral upper respiratory infection, such as a runny nose, cough, and body aches, but you do not have a high fever, you most likely have a cold virus, not strep throat.

Linder pointed out that a big overlap exists between those signs and symptoms and those associated with the flu. However, people with the flu typically have more than just a sore throat, they also have body aches, a high fever, and a cough; strep throat in adults is almost never associated with a cough.

Assuming that you do not have a strep throat, you need rest, fluids, and something for the fever and aches and pains, like acetaminophen or ibuprofen, said Linder. His advice: “The best treatment really is a little bit of time, to allow things to get better on their own.” Most sore throats will get better on their own in five to seven days.

The study is published online in JAMA Internal Medicine.

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