Acute Sore Throat: Antibiotics Should Normally Not Be Started Immediately

Main Category: Ear, Nose and Throat
Also Included In: Infectious Diseases / Bacteria / Viruses;  Pediatrics / Children's Health;  Respiratory / Asthma
Article Date: 22 Apr 2008 - 2:00 PDT

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An expert-session held by Prof. Paul Little (Southampton, UK), at the 18th European Congress of Clinical Microbiology and Infectious Diseases in Barcelona, has focused on sore throat (pharyngitis/tonsillitis), one of the most common presentation of an acute infection.

At least once a week general practitioners see patients with acute sore throat, which is more frequent in autumn and winter. It is also one of the most common complaints for which children visit their pediatricians. The problem is even huger because only a small proportion of people with sore throat (approximately 1 in 10 persons) seek medical attention. In healthy people, a sore throat is usually self-limiting.

Enlargement and redness of the tonsils and inflammation of the pharynx are usually present; anterior neck glands might be enlarged and tender. Sometimes people also complain of headache, nausea and vomiting, malaise, dysphagia, or abdominal pain.

Only 15-30% of all sore throats are caused by pathogen bacteria (most frequently group A streptococci), and therefore would benefit from antibiotic therapy. That's why both in adults and in children, antimicrobial treatment is often unnecessary, since most infections are of viral origin. Prof. Little has provided the following suggestions in case of sore throat.

First of all, do not take immediately antibiotics! "There are several alternatives to consider: if rapid streptococcal test are available (this test is very cheap, less than 5 euros) at your doctor office, it takes just 5 minutes to exclude or confirm a group A streptococcal infection. If a rapid test is not available, it is still safe to wait 3 days before using antibiotics.

If the symptoms are not starting to settle within 3-4 days you can start antibiotic therapy. In the meantime you can take antinflammatory drugs to control the symptoms. This is because the benefit from antibiotic for the majority of people is low.

Actually, most people only get disadvantages from taking antibiotics (these include: modifying the commensal bacterial flora, which are important in fighting infection, and other side effects such as diarrhoea, allergic responses and antibiotic resistance).

"If your sore throat is persisting for a week or if you are very unwell (high temperatures, or unable to swallow) you need to see the doctor". If an antibiotic is used, Penicilln V (phenoxymethyl penicillin, which is a generic drug in many countries) at high dosage (1 g twice a day for a week) is considered the treatment of choice. In areas where streptococcal resistance to penicillin is higher (Southern Europe) microbiologists will provide the best advice for an effective treatment.

18th ECCMID (European Congress of Clinical Microbiological and Infectious Diseases), Barcelona, Spain
http://www.akm.ch/eccmid2008

European Society of Clinical Microbiology and Infectious Diseases