In recent years, physicians have been strongly encouraged by public health experts to more carefully prescribe antibiotics, to prescribe them less often by using tests with greater diagnostic accuracy, and to avoid giving a broad-spectrum antibiotic when a more specific one will do. Bacteria are quick learners and can change their makeup to allow them to survive despite the presence of antibiotics. Overuse of antibiotics has been responsible for making many bacteria less responsive to available antibiotics. Preventing bacterial “superbugs”—organisms that can resist our strongest antibiotics—is the major reason for this more cautious approach. Cost savings are another reason.

When examining a patient for a complaint of sore throat, a physician tries to determine if the problem is due to a virus or bacteria. Most sore throats are due to viruses in the upper respiratory tract. As an article in the November 9, 2005 issue of the Journal of the American Medical Association by Linder et al, reminds us, the main bacterial cause of sore throat and the only common cause of sore throat warranting antibiotic treatment is group A beta-hemolytic streptococci, commonly called “strep throat.”

The JAMA articles goes on to say that before a child is given a prescription for an antibiotic for a sore throat, a strep test (either the rapid strep test or a throat culture) should be performed. This is the recommendation of the American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America. If only the rapid strep test is performed and the test results are negative and the patient is still suspected of having strep based on clinical symptoms, cultures should be obtained. The test helps ensure not only that a prescription for antibiotics will be effective for the individual, but that the population will be better protected against drug-resistant organisms.

Some people may be sent home with a prescription before the test results are known. If your healthcare provider informs you that the results of your strep test are negative, be sure to ask whether you should stop taking the drug immediately. Taking unnecessary medication not only adds to the drug-resistance problem, but puts you at risk of side effects and adverse drug events.

The JAMA article noted that the trend of prescribing antibiotics is improving somewhat—that, over the 9-year period from 1995 to 2003, physicians in the study were prescribing fewer and more appropriate antibiotics for children with sore throat. In part, this progress is due to physicians becoming aware of the serious problem of overprescribing; also, physicians are more often using strep tests to appropriately aid in diagnosis. The data, however, are not all good. In this study, the rate at which antibiotics were prescribed overall was still greater than expected, given the prevalence of strep infection. Thus, health consumers may want to ask their healthcare providers if a prescription is necessary or if another drug might be a better choice.

Some physicians have begun using electronic decision support systems to help them make better clinical decisions for each case, including when to prescribe antibiotics for a sore throat and which antibiotics to prescribe. A study in the November 9, 2005 issue of the Journal of the American Medical Association by Samore et al found that such tools could be helpful in getting physicians to appropriately prescribe antimicrobial drugs for respiratory tract infections.

As an informed healthcare consumer, here are some steps you may wish to take if you or a family member become sick with a sore throat:

Ask your healthcare provider if an antibiotic is appropriate treatment for your illness.

Ask if a strep test would help make an accurate diagnosis and confirm your need for antibiotics.

Get the test results. When a throat culture is done, call the doctor’s office if they do not call you in the agreed-upon time.

Follow the instructions on an antibiotic prescription: take all of the medication as directed unless your doctor tells you to stop.

Sources
S1
Bisno AL, Gerber MA, Gwaltney JM Jr, Kaplan EL, Schwartz RH. Practice guideline for the diagnosis and management of group A streptococcal pharyngitis. Clin Infect Dis. 2002;35:113-125.

S2
Linder JA, Bates DW, Lee GM, Finkelstein JA. Antibiotic treatment of children with sore throat. 9 Nov 2005. JAMA;294:2315-2322.

S3
Samore, MH, Bateman K, Alder SC, et al. Clinical decision support and appropriateness of antimicrobial prescribing: a randomized trial. 9 Nov 2005. JAMA:294:2305-2314.