Sore throats, why the dilemma?

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7392.766/a (Published 05 April 2003) Cite this as: BMJ 2003;326:766
  1. Larry Martel, consultant paediatrician (martel{at}doctors.org.uk)
  1. Warren Children's Centre, Lisburn, Northern Ireland BT28 1LQ

    EDITOR—With reference to the article by Kumar et al, I find it hard to believe that the argument still goes on about the treatment of sore throats.1 If I had the energy I would dig up the articles to support the following statements.

    Firstly, the only probably treatable organism in the throat is streptococcus, virtually all else is viral.

    Secondly, during the second world war the US government decided that the only sensible treatment was to give all troops complaining of a sore throat an injection of penicillin. They were unlikely to complete a 10 day course of antibiotics orally, and the risk of anaphylaxis was less than the risk of a war injury.

    Thirdly, multiple studies show that it is very difficult to get anyone to complete a 10 day course of penicillin.

    Fourthly, drug resistance is on the rise due to overuse of antibiotics.

    Fifthly, rapid tests for streptococci have been available for over 10 years. They can give reliable results within minutes and have been standard practice in the United States for ages but very unpopular with UK authorities. Could it be because the penicillin is cheaper than the test?

    Sixthly, there is only weak evidence that treating strep throat with antibiotics hastens resolution of symptoms, but we would like to believe that it will reduce the presence of secondary complications such as rheumatic fever and quinsy (but not glomerulonephritis).

    If you are determined to reduce the overuse of antibiotics either do a culture and wait 24–48 hours to treat positive results or do a rapid strep test and treat patients whose results are positive. Either strategy will prevent complications and would be equally efficacious in relieving symptoms. In the developing world or inner cities, where only relatively ill patients come to the doctor and compliance is difficult, an injection of penicillin or short course of azithromycin is sensible. Once the patients realise that the complaint of sore throat is greeted with an injection they will be very judicious of their use of the doctor's services.


    • Competing interests None declared.


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