Intended for healthcare professionals

Primary Care

Penicillin for acute sore throat in children: randomised, double blind trial

BMJ 2003; 327 doi: (Published 04 December 2003) Cite this as: BMJ 2003;327:1324

Practical approach

For many years I adopted the "British approach" to sore throat
therapy, i.e, take a throat culture and start treatment.
In case the culture is negative therapy stopped. Otherwise - continued for
10 days.

The rationale behind the approach is the simple fact that even the best
and the most experienced pediatrician, can diagnose, on clinical ground,
no more that 60% of streptoccocal infection.
Secondly, unlike the trial to "intimidate" pediatrician of penicillin
anaphylaxis, oral peniciillin is extermly rare in children if exist at

The boldness not to treat, because the long term sequele of strep.
infection, are minimal in the western hemisphere, is unsound.

The rarity of post strep. events, could easily be attributed to the "ad
libitum" antiboiotic therapeutic attitude to sore throat, rather than
miraculousley irradication of rheumatic fever.

The possibility of developing of therapeutic resistant is true. It should
be tackled by preaching the avoidance of broad spectrum antibiotics,
while the "hard-worker" oral penicillin can do the job.
Last but not least, besides the tendency for evidece based medicine, the
defensive medical attitude is flourishing.

In spite of the argumentation for and against the use of antibiotics in
sore throat, as long as there is no concensus, every unwarranted side
effect of untreated sore throat, which will be dragged into court room,
will wind up with malpractice verdict against the medical community, as
happened more than once, at least, in Israel.

Competing interests:
None declared

Competing interests: No competing interests

08 December 2003
Prof. REuben steinherz
General sick fund, Israel