Education And Debate

Careful prescribing is beneficial

BMJ 1994; 309 doi: (Published 15 October 1994) Cite this as: BMJ 1994;309:1011
  1. Pesach Shvartzman, chairmana
  1. a Department of Family Medicine, University Center for Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, POB 653, Israel

    The annual incidence of sore throat in general practice has been estimated at 100 per 1000 people per year.1 Some doctors prescribe antibiotics for every patient presenting with a sore throat. Others use clinical scoring systems to establish the probability of group A ß haemolytic streptococcal infection. They use the score result together with a knowledge of the prevalence of streptococci in the community to derive a treatment strategy.2 Thus the management of sore throat, although essentially simple, illustrates Osler's dictum that medicine is a science of uncertainty and an art of probability.3

    Bacteria can be isolated from 40-50% of patients with sore throat who present to general practitioners, although up to 30% of those with positive cultures may be carriers.4 Group A ß haemolytic streptococci are the most common bacterial pathogens, with Corynebacterium diphtheriae, and group C and group G streptococci much rarer. An increasing number of cases may be due to synergistic infection with Staphylococcus aureus, Moraxella catarrhalis, Haemophilus influenzae, or anaerobic organisms. Recently, evidence has emerged that some cases of non-streptococcal pharyngitis may be associated with mycoplasma and chlamydial infections.4

    Reduction of complications

    A large study of patients with acute tonsillitis in 17 European countries found that 90% were treated with antibiotics.5 Since up to half of patients with sore throats have positive bacterial cultures, it is natural to consider such treatment for every patient. This policy is supported by a recent analysis of strategies for dealing with sore throat in which the likelihood of rheumatic fever after untreated streptococcal infection was assumed to be 37.5 times …

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