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Antibiotics worthless for most throat infections

Robin Wulffson MD's picture
strep throat, viralinfection, antibiotics, penicillin, penicillin allergy

Not uncommonly, when one comes down with a sore throat, they visit their physician and request an antibiotic. Sometimes, they merely call the office and ask for an antibiotic to be called in to their pharmacist. According to a new study, this is often a poor choice because most throat infections are viral in origin; thus, not susceptible to antibiotics.

New guidelines for the treatment of throat infections were published online on September 9 in the journal Clinical Infectious Diseases.

According to the guidelines, up to 70% of Americans with a sore throat receive antibiotics; however, bacteria are responsible for only 20% to 30% of pediatric cases and 5% to 15% of adult cases. The authors note that bacterial and viral throat infections often have overlapping symptoms; however, other symptoms, such as cough, rhinorrhea (runny nose), hoarseness, and oral ulcers, strongly suggest a viral infection. They note that a sore throat is more likely to be caused by group A streptococcus if the onset of pain is sudden, swallowing is painful, and a fever is present. They explain that strep infections can be promptly diagnosed using a stand-alone rapid antigen detection test. They caution that children under the age of three are unlikely to have strep throat; therefore, testing this age group is unnecessary, with the exception of certain circumstances such as an infected older sibling.

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The guidelines recommend that throat cultures should only be used to confirm negative antigen tests in children and teens. They note that throat cultures are not recommended for adults because of their low risk for strep throat and even lower risk for complications such as rheumatic fever. If a strep throat infection is confirmed, the current treatment of choice remains a 10-day course of penicillin or amoxicillin; these antibiotics have a narrow spectrum of activity, are inexpensive, and have a low risk for adverse events. An antibiotic with a narrow spectrum has activity against only certain types of bacteria—in this case streptococci. Thus, they do not act against other bacteria, which may be beneficial.

Some individuals are allergic to penicillin. In these instances the guidelines suggest the following antibiotics for strep throat: cephalexin, cefadroxil, clindamycin, azithromycin, or clarithromycin.

At one time, children with recurrent sore throats underwent a tonsillectomy. However, the guidelines recommend that this procedure should only be performed under certain specific circumstances such as obstructed breathing. The guidelines note that, in most case, only a short-term benefit is achieved and this benefit is countered by surgical risk.

Reference: Clinical Infectious Diseases