For years, there has been concern that antibiotics are overprescribed, and with good cause. Despite clear guidelines calling for prior testing, physicians prescribed antibiotics in 53 percent of sore throat cases in children, researchers from Brigham and Women's Hospital (BWH) and Children's Hospital Boston found in a recent study.
This represents significantly more prescriptions than warranted for actual rates -- 15-36 percent -- of strep throat among kids with sore throat. Furthermore, almost half of those prescriptions were given in the absence of a test. Details of this research appear in the November 9, 2005, issue of the Journal of the American Medical Association.
Group A streptococcal pharyngitis, or strep throat, is the most common cause of sore throat for which antibiotics are indicated. However, many leading health organizations, including the Centers for Disease Control and Prevention and the American Academy of Pediatrics say that a common "strep" test should be performed prior to prescribing recommended antibiotics.
Antibiotic-Resistant Bacteria
"This study demonstrates that children with sore throat are frequently given unnecessary antibiotics," says lead author Jeffrey A. Linder, MD, MPH, a BWH internist.
"This overprescribing of antibiotics could be easily remedied by following known guidelines, which include doing a simple, inexpensive strep test," he adds.
"This is critical for not just children but all patients," Dr. Linder notes, "as unnecessary prescription of antibiotics can lead to a variety of issues, including increased costs, the potential development of antibiotic-resistant bacteria, and adverse drug effects."
Researchers analyzed data from children aged 3 to 17 years from 1995 to 2003 with sore throat who visited office-based physicians, hospital outpatient departments and emergency departments.
Among an estimated 7.3 million visits for sore throat over this time period, physicians prescribed antibiotics in 53 percent of the cases, the researchers found.
Just 15 to 36 percent of children with sore throat actually have the strep throat bacterium, according to estimates. But only 53 percent of those who were given the antibiotics had been tested first.
Testing Is Underused
Over the eight-year time period of the study, physicians prescribed antibiotics less frequently, the researchers found, which suggests an encouraging trend. In 1995, 66 percent of cases were given antibiotics, decreasing to 54 percent of cases in 2003.
Still, there was no decrease in the prescribing of non-recommended antibiotics, which made up 27 percent of antibiotic prescriptions, Dr. Linder points out. Recommended antibiotics for the treatment of strep throat are penicillin, amoxicillin, erythromycin and first-generation cephalosporins.
"Strep testing is underused, and physicians should be ordering this important diagnostic test before prescribing antibiotics to kids with sore throat," emphasizes Dr. Linder.
"Instead of writing a prescription, physicians should order a test and make sure they are treating kids' symptoms by offering a pain medication like acetaminophen or ibuprofen," he advises.
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