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Penicillin for acute sore throat: randomised double blind trial of seven days versus three days treatment or placebo in adults

BMJ 2000; 320 doi: (Published 15 January 2000) Cite this as: BMJ 2000;320:150

Rapid Response:

Antibiotics for sore throats? inappropriate therapy in the new mellennium

This article concerns me in 2 ways, firstly with the methodology, but
secondly and more importantly that it was concieved at all, in view of the
issue of antibiotic usage.

The study had an unusually high number of exclusions (36,7%). Not all
the patients were randomised (26.6%).The secret code of treatment was
broken at the wish of the doctor or the patient. There was a faster
resolution of the patients in the 7 day treatment arm at 2 days, as
compared to the 3 day treatment arm at 2 days despite identical
treatment,and I am not entirely sure of the explanation given by the
authors.Another possibility concerning all the above points is that the
randomisation was not successful, and therefore the results of the trial
may not be secure.

However, these doubts are minor compared to the real issue which is
how we use this precious resouce of antibiotics handed to us by our
predecessors. Resistance to commonly used antibiotics is rising
fast(1).The increasing use of antibiotics encourages resistant organisms
within individuals themselves, and within the community (2).In the
majority of cases antibiotics do not prevent complications
(3),(4).Finally, antibiotics have at best mild to modest benefit in
pharangitis (5).

If we continue to prescribe antibiotics for self limiting illnesses
where there is small benefit at most, we will see an increase in incidence
of seious resistant infections such as pneumonia and meningitis, and
inevitably assosiated mortality. Our resolution for the new millennium
should be to stop prescribing antibiotics for minor self limiting
conditions, allow nature to heal these in her successful way, and save
antibiotics for what they were designed for in the first place-- serious
and life threatening disease.

(1)Johnson AP, Speller DCE, George RC, Warner M, Domingue G,
Efstratiou A Prevalence of antibiotic resistance and serotypes in
pneumococci in England and Wales : results of observational studies in
1990 and 1995 BMJ 1996;312:1454-6

(2)Arason VA, Kristinsson KG, Sigurdsson JA, Stefansdottir G, Molstad
S, Gudmundsson S do antimicrobials increase the carriage rate of
penicillin resistant pneumococci in children? Cross sectional prevalance
study BMJ 1996;313:387-91

(3)Howie JGR, Foggo BA Antibiotics, sore throats, and rheumatic fever
JRCGP 1985;35:223-4

(4)Taylor JL, Howie JG, antibiotics, sore throats and acute

(5)Clinical Evidence. BMJ publishing issue 2 dec 1999 page586

Competing interests: No competing interests

19 January 2000
R Fleetcroft
GP principal, trainer, tutor, clinical governance lead
Hemsby Norfolk UK