Antibiotics for sore throats

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6971.58b (Published 07 January 1995) Cite this as: BMJ 1995;310:58

Patient and doctor should reach decision together

  1. Christopher Del Mar
  1. Reader General Practice Unit, Medical School, University of Queensland, Herston, Queensland 4007, Australia

    EDITOR,—Both papers representing the two sides in the controversy over whether antibiotics should be given for sore throats seem to miss the point.1 That by P S Little and I Williamson concludes that antibiotics provide so little benefit that this is outweighed by the costs and that general practitioners should therefore have a policy of not using them. The other, by Pesach Shvartzman, suggests that there is insufficient information to deny patients a possible benefit of antibiotics for sore throat; the final sentence implies, therefore, that all patients with sore throats should be treated with antibiotics. In the accompanying commentary Peter Rubin regrets the paucity of data and asks for more research.

    More research would probably only confirm what we already know: that antibiotics confer significant benefits in terms of relief of symptoms and prevention of suppurative complications and acute rheumatic fever.2 The question is, are these benefits clinically important? Is a mean shortening of symptoms by eight hours in an illness whose mean duration is three to four days worth a visit to a doctor and the risks of antibiotic treatment (of which probably diarrhoea, candidiasis, and rashes are the most common)? Probably the only person who can answer this question is the patient.

    Our job is not to attempt to formulate a universal policy or even to best guess the causative agent for each person. Rather it is to achieve a common understanding with patients.3 This is not easy: “You have a 90% chance of being symptom-free in seven days whether or not you use antibiotics: however, with penicillin you have a 50% chance of being symptom-free on day 3 rather than day 31/2.”2 The challenge is in explaining to our patients the small size of the benefits of antibiotics, derived from empirical research, rather than relying on simplistic concepts of killing bacteria that are susceptible to the antibiotic but may or may not be causing the infection.


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