Each year, millions of children visit their family physician or pediatrician seeking treatment for sore throats. While a sore throat could indicate many common illnesses, physicians are often most concerned about bacterial infections that warrant antibiotic treatments. The most common cause of sore throat for which antibiotics are indicated is group A streptococcal pharyngitis, or "strep throat." Many leading health organizations such as the Centers for Disease Control and Prevention and the American Academy of Pediatrics indicate that a common streptococcal or "strep" test be performed prior to prescribing recommended antibiotics.
For years, physicians have been concerned about the over-prescription of antibiotics and now, researchers from Brigham and Women's Hospital (BWH) and Children's Hospital Boston have found that despite clear guidelines, physicians prescribed antibiotics in 53 percent of cases. This represents significantly more prescriptions than what is expected for actual rates – 15 to 36 percent – of strep throat among kids with sore throat. Details of this research will be published in the November 9, 2005 issue of the Journal of the American Medical Association.
According to lead author Jeffrey A. Linder, MD, MPH, a BWH internist, "This study demonstrates that children with sore throat are frequently given unnecessary antibiotics. This over-prescribing of antibiotics could be easily remedied by following known guidelines, which include doing a simple, inexpensive strep test before giving antibiotics. This is critical for not just children but all patients as unnecessary prescription of antibiotics can lead to a variety of issues including increased costs, the potential development of antibiotic resistant bacteria and adverse drug effects."
Researchers analyzed data from children aged 3 to 17 years from 1995 to 2003 with sore throat who visited office-based physicians, hospital outpatient departments and emergency departments as identified by the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Researchers found among an estimated 7.3 million visits for sore throat over this time period, physicians prescribed antibiotics in 53 percent of the cases. Among these cases, only 53 percent – a little more than one-half – received a strep test. According to the analysis, this is higher than the estimated 15 to 36 percent of children with sore throat who actually have the strep throat bacterium.
Encouragingly, over the eight-year time period of this study, researchers found physicians prescribed antibiotics less frequently – from 66 percent of cases in 1995 to 54 percent of cases in 2003. However, Linder said the researchers are concerned that there was no decrease in the prescribing of non-recommended antibiotics, which made up 27 percent of antibiotic prescriptions. Recommended antibiotics for the treatment of strep throat are penicillin, amoxicillin, erythromycin and first-generation cephalosporins.
"Strep testing is underused and physicians should be ordering this important diagnostic test before prescribing antibiotics to kids with sore throat," said Linder. "Instead of writing a prescription, physicians should order a test and make sure they are treating kids' symptoms by offering a pain medication like acetaminophen or ibuprofen."
