Applying evidence on small effects is hard; variations are probably inevitable

General practice p 150

The liberal use of antibiotics for sore throats is increasingly frowned on.1 There are three reasons why a clinician might use antibiotics for sore throat: to reduce the risk of complications, to shorten (or reduce the severity of) symptoms, and because of factors related to the consultation (perceived patient demand, ways of terminating the consultation, and so on). Nearly 30 years ago Howie showed a huge variation in different general practitioners' use of antibiotics for sore throat.2 Have general practitioners been thirsting for information on which to base their management? The notion that summarising evidence about an area of care will result in a sort of regulation of doctors' management appears to be naive. A Cochrane review summarising the advantages of antibiotics for sore throat has been available for several years.3 But there is nothing to suggest that there is less variation in practice. General …