This article is more than 5 years old. Information may no longer be current.

Antibiotics offer little benefit in treating sore throats

Longer courses of antibiotics did not have a significant effect on sore throat outcomes compared with a shorter antibiotic course, and delayed antibiotics had similar benefits to immediate antibiotics, according to two studies published in the British Journal of General Practice.

Both studies used data from the Decision rule for the Symptoms and Complications of Acute Red Throat in Everyday practice (DESCARTE) study, which included adults aged 16 and older who presented to a general practice in the United Kingdom for an acute sore throat that lasted 2 or more weeks.

Delayed vs. immediate antibiotics

In the first study, Michael Moore, FRCGP, of the primary care population sciences division at the University of Southampton, U.K., and colleagues performed a secondary analysis of 2,876 participants from the DESCARTE study to evaluate whether a delayed antibiotic prescription had an impact on reducing symptoms compared with immediate antibiotics or no antibiotics.

Researchers gathered symptom severity information, exam findings and outcomes from all the participants in the secondary analysis. A symptom diary was also obtained from 57% of participants. The primary outcome was re-consultation with non-resolving/new symptoms within 1 month, and the secondary outcome was “poorer” symptom control — longer than the median duration or higher than median severity.

Moore and colleagues found that the proportion of patients with poorer global symptom control was greater in those not prescribed antibiotics (68%) compared with those prescribed immediate antibiotics [(61%) RR = 0.87; 95% CI, 0.7-0.96] or delayed antibiotics [(59%) RR = 0.88; 95% CI, 0.78-1). This finding was consistent when controlling for baseline severity, according to researchers.

In addition, researchers wrote that secondary outcomes showed a reduction in symptom severity on days 2 to 4, and on average, 1 day less of moderately bad symptoms was endured by those participants who received an immediate antibiotic.

“Although adoption of the non-prescribing strategy results in the lowest uptake of antibiotics, use of a delayed prescription may be a useful option where current prescribing rates are high or there is greater concern for complications,” Moore and colleagues wrote.

“It is recognized that there is a trade-off between lower antibiotic prescribing and patient satisfaction with both doctors and practices, although clinical trials have not demonstrated large differences in satisfaction between immediate and delayed prescribing. There is also likely a trade-off between a global reduction in prescribing and an increased risk of septic complications, although the absolute increase is very small.”

Antibiotic duration

In the second study, the same researchers attempted to determine from 12,677 participants of the DESCARTE study whether antibiotic duration predicted adverse outcomes of acute sore throat. The primary outcome was re-consultation with non-resolving/new symptoms within 1 month, and the secondary outcome was “poorer” symptom control.

“Systematic reviews and randomized trials of antibiotics for acute sore throat have found only a modest effect on symptoms. However, prescribing antibiotics may still be indicated in some instances,” the researchers wrote. “Evidence about appropriate duration of the antibiotic treatment for acute sore throat in adults in the modern era is needed.”

Moore and colleagues found that antibiotics were prescribed for 62% of the participants. The most frequently prescribed antibiotic was phenoxymethylpenicillin (76%) and prescription durations for 7 days (57%), 10 days (22%) or 5 days (20%).

Researchers found that when compared with 5-day courses, those receiving longer courses were less likely to re-consult with new or non-resolving symptoms but these differences did not reach statistical significance.

“When antibiotics are indicated, current guidelines recommend a 10-day course. [We] found that a 10-day course of antibiotics was not associated with greater benefit on either risk of re-consultation or symptom control, compared with 5- or 7-days antibiotic duration,” Moore and colleagues wrote. “In situations where bacterial eradication is not specifically needed, and where symptomatic cure is the goal, if a decision to prescribe is made then a shorter course of penicillin may be sufficient, and this finding should be confirmed with a randomized controlled trial.”

Researchers also cautioned that these findings should not be considered applicable to areas with higher occurrence of acute rheumatic fever. – by Janel Miller

Disclosure: The authors report no relevant financial disclosures.