Antibiotics for Sore Throat

Abstract

Background: Sore throat is a common reason for people to present for medical care. Although it remits spontaneously, primary care doctors commonly prescribe antibiotics for it.

Objectives: To assess the benefits of antibiotics for sore throat for patients in primary care settings.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2011, Issue 2, which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (January 1966 to May week 1, 2011) and EMBASE (January 1990 to May 2011).

Selection criteria: Randomised controlled trials (RCTs) or quasi‐RCTs of antibiotics versus control assessing typical sore throat symptoms or complications.

Data collection and analysis: Two review authors independently screened studies for inclusion and extracted data. We resolved differences in opinion by discussion. We contacted trial authors from three studies for additional information.

Main results: We included 27 trials with 12,835 cases of sore throat.

1. Non‐suppurative complications: The trend was antibiotics protecting against acute glomerulonephritis but there were too few cases to be sure. Several studies found antibiotics reduced acute rheumatic fever by more than two‐thirds within one month (risk ratio (RR) 0.22; 95% confidence interval (CI) 0.02 to 2.08).

2. Suppurative complications: Antibiotics reduced the incidence of acute otitis media within 14 days (RR 0.30; 95% CI 0.15 to 0.58); acute sinusitis within 14 days (RR 0.48; 95% CI 0.08 to 2.76); and quinsy within two months (RR 0.15; 95% CI 0.05 to 0.47) compared to those taking placebo.

3. Symptoms: Throat soreness and fever were reduced by using antibiotics by about half. The greatest difference was seen at day three. The number needed to treat to benefit (NNTB) to prevent one sore throat at day three was less than six; at week one it was 21.

4. Subgroup analyses of symptom reduction: Antibiotics were more effective against symptoms at day three (RR 0.58; 95% CI 0.48 to 0.71) if throat swabs were positive for Streptococcus, compared to RR 0.78; 95% CI 0.63 to 0.97 if negative. Similarly at week one, RR 0.29; 95% CI 0.12 to 0.70 for positive, and 0.73; 95% CI 0.50 to 1.07 for negative Streptococcus swabs.

Authors' conclusions: Antibiotics confer relative benefits in the treatment of sore throat. However, the absolute benefits are modest. Protecting sore throat sufferers against suppurative and non‐suppurative complications in high‐income countries requires treating many with antibiotics for one to benefit. This NNTB may be lower in low‐income countries. Antibiotics shorten the duration of symptoms by about 16 hours overall.