Mistreating Sore Throats

A huge number of antibiotic prescriptions are filled due to the misdiagnosis of sore throats. Here's something from the archives about this problem while I'm away.

A long-standing complaint by many microbiologists has been the mistreatment of sore throats in children. Antibiotics are often prescribed even though they are usually ineffective (italics mine):

Most children with sore throats are given antibiotics when they see their doctors, even though a large majority of the ailments are caused by organisms that do not respond to the drugs, a new study has found.

The only common cause of sore throat that can be cured with an antibiotic is streptococcus infection, but it occurs in only 15 percent to 36 percent of cases of sore throat.

The study, published last week in The Journal of the American Medical Association, analyzed data from two large national surveys undertaken from 1995 to 2003. Researchers found that 53 percent of children complaining of sore throat were prescribed antibiotics, and more than a quarter of them were given the wrong one.

"The bug that causes strep is never resistant to penicillin," said Dr. Jeffrey A. Linder, the lead author of the study and an internist at Brigham and Women's Hospital in Boston, so unless the patient is allergic to it, there is little reason to use anything else.

"Doctors are prescribing something more expensive that the bug is sometimes resistant to," Dr. Linder said.

The recommended practice is to take a strep test, but only about half of the children given the medicines were tested.

A rapid test can be done in minutes, but it is less accurate than growing a culture, which takes two to three days.

"It's totally acceptable to start an antibiotic while the throat culture is cooking," Dr. Linder said, but he warns that "it should be stopped if the culture is negative."

The study also found that nonwhites and Southerners were more often prescribed antibiotics than whites or people in other regions of the country. "This is one place where people getting more care are getting worse care," Dr. Linder said.

While we're on the topic of antibiotics, the observation that 'antibacterial' hand soaps don't lower the incidence of disease has prompted the FDA to examine whether triclosan is actually creating a health problem through selection for triclosan resistant organisms.