Use of antibiotics for acute sore throat and tonsillitis in primary care

Christopher R Wilcox; Michael Moore; Paul Little

doi:10.3399/bjgp22X718793

Antibiotics are commonly prescribed for sore throat in primary care, yet are often of limited benefit.¹ They are commonly associated with adverse effects, and contribute towards healthcare costs and antibiotic resistance at both the global and individual level.¹ Prescribing antibiotics also reinforces patients’ belief in the need for antibiotics, and increases the chance of re-attendance in the future.²

With a view to helping clinicians optimise antibiotic use, this article summarises evidence concerning the aetiology and natural history of sore throat, incidence of complications, and the use of clinical prediction tools, and compares the outcomes of different antibiotic prescription strategies (no, immediate, and delayed antibiotics), as well as patients’ views on these approaches.

ANTIBIOTICS AND THE NATURAL COURSE OF ILLNESS IN SORE THROAT

Around two-thirds of cases are viral (higher in children), and the remainder are usually caused by group A beta-haemolytic streptococci (particularly Streptococcus pyogenes), and, less commonly, group C and G streptococci.¹^,³ Sore throat is also a feature in approximately 50% of mild-to-moderate COVID-19 disease.⁴

The latest Cochrane review found that, among patients not prescribed antibiotics, 40% were symptom free by day 3 of illness, and 80% were symptom free by 1 week.¹ This was similar in Streptococcus-positive, -negative, and untested participants. On average, antibiotics reduced the duration of symptoms by 16 hours.¹