Education And Debate

Controversies in Management: Are antibiotics appropriate for sore throats? Costs outweigh the benefits

BMJ 1994; 309 doi: http://dx.doi.org/10.1136/bmj.309.6960.1010 (Published 15 October 1994) Cite this as: BMJ 1994;309:1010
  1. P S Little,
  2. I Williamson
  1. Department of Primary Medical Care, Aldermoor Health Centre, Southampton University, Southampton SO1 6ST.

    General practitioners prescribe antibiotics for sore throat for various reasons including to prevent complications (rheumatic fever, glomerulonephritis, sinusitis, otitis media, etc), to relieve symptoms, and for psychosocial reasons. However, the benefit is marginal and the costs are great.

    Do antibiotics prevent complications?

    Studies on the prevention of rheumatic fever were carried out using penicillin injections in military personnel in barracks after the second world war.1 The attack rates were high (0.3-5%), and the results may not be generalisable to a modern community setting with lower attack rates and where the likelihood of developing rheumatic fever or glomerulonephritis is the same in those who have and have not had oral antibiotics.2,3 The incidence of rheumatic fever has been falling since the turn of the century - well before antibiotics were discovered.4 General practitioners in Britain have about a one in five chance of every seeing a patient with either post-streptococcal glomerulonephritis or rheumatic fever after a sore throat.2,3

    *This is the seventh in a series of articles examining some of the difficult decisions that arise in medicine

    The main problem of prescribing to …

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