If you are reading this post, you have repeatedly heard the cautions about avoiding overuse and inappropriate prescribing of antibiotics. Well, the national experts who continue warning us on this topic feel they are speaking into deaf ears. A recent JAMA Internal Medicine article showed just how little we physicians are hearing the experts’ voices. In a review of over 8,000 visits to primary care clinicians and ED’s for sore throat from 1997 – 2010, antibiotics were prescribed 60% of the time and there was no significant downward trend over this time frame. Compared to 1993, there has been a small decrease in antibiotic prescribing. At that time, about 70% of such visits yielded an antibiotic prescription.
Other studies have shown the rate of Group A strep in patients with pharyngitis is about 10%. While I was never a star in math class, I can do the calculation reasonably well. Six times more patients are being prescribed antibiotics than need them.
There are many reasons we continue to ignore best practices in treating pharyngitis. Prescribing an antibiotic saves time explaining to patients the lack of efficacy and the potential risks, and we are always running behind in clinic. Patients are often happier if they get an antibiotic. Many patients will vouch for the fact that every time the doctor avoided giving them antibiotics in the past, their sore throats continued on and on until they finally had to come back in to see a doctor who did give them antibiotics. And of course their sore throats cleared up within a few hours of taking the first antibiotic pill. Then, there is also an understandable concern that if one does not prescribe antibiotics, perhaps the patient does in fact have a strep infection and could be at risk for other problems, short- and long-term.
So, I’m not going to get on my high horse and say “Tut, tut, tut.” But I will say it is always a good idea to think twice or thrice before prescribing antibiotics for a sore throat. Rapid strep screen testing is readily available in many clinics, and can provide reassurance, to patient and clinician alike.
Richard Fleming, MD