Antibiotics for sore throat

Antibiotics confer relative benefits in the treatment of sore throat, but the absolute benefits are modest. Antibiotics can reduce the chance of rheumatic fever in communities where this complication is common.

A Cochrane review included 27 studies with a total of 12 835 cases of sore throat. The majority of studies were conducted in the 1950s. Seven more recent studies were included (1996 to 2003).

2. Symptoms
   • Throat soreness and fever were reduced by antibiotics by about half. The greatest difference was seen at day 3 (when the symptoms of about 50% of untreated patients had settled). The number needed to treat (NNT) to prevent one sore throat at day 3 was less than six; at one week it was 21.
3. Non-suppurative complications
   • There was a trend for antibiotics to protect against acute glomerulonephritis, but there were insufficient cases to be sure. Several studies found antibiotics reduced acute rheumatic fever by more than two thirds (RR 0.22; 95% CI 0.02 to 2.08).
4. Suppurative complications
   • Antibiotics reduced the incidence of acute otitis media (RR 0.30; 95% CI 0.15 to 0.58); of acute sinusitis (RR 0.48; 95% CI 0.08 to 2.76); and of quinsy (peritonsillar abscess) compared to those taking placebo (RR 0.15; 95% CI 0.05 to 0.47).
   Symptoms Throat soreness and fever were reduced by antibiotics by about half. The greatest difference was seen at day 3 (when the symptoms of about 50% of untreated patients had settled). The number needed to treat (NNT) to prevent one sore throat at day 3 was less than six; at one week it was 21.
5. Subgroup analyses of symptom reduction
   • Analysis of results of throat swabs showed that antibiotics were more effective against symptoms at day 3 (RR 0.58, 95% CI 0.48 to 0.71) if the swabs were positive for Streptococcus, compared to RR 0.78 (95% CI 0.63 to 0.97) if negative. Similarly at week 1, RRs 0.29 (95% CI 0.12 to 0.70) for positive, and 0.73 (95% CI 0.50 to 1.07) for negative swabs.

Clinical comment: In some countries (e.g. Finland, France, USA) the decision of antibiotic treatment is usually based on the results of positive throat swab or quick test for Streptococcus, while in many other countries clinical diagnosis in considered adequate. Quick diagnosis of group A streptococci was not attempted in most trials, and the treatment was not confined to patients with positive results.

Ədəbiyyat

1. Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database Syst Rev 2013;11():CD000023.