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Pharyngitis (Sore Throat): Antibiotics Are Overused

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Pharyngitis related image Photo: Getty Images

Sore throat is one of the most common symptoms that sends people to doctor's offices. Antibiotics can help if the cause of a sore throat is bacterial, but most cases are caused by viruses.

Dr. Duane K. Undeland and colleagues at Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin, studied data from 4,996 patients to see how well clinicians follow treatment guidelines for appropriate antibiotic use.

On the first visit, physicians adhered to antibiotic-prescribing guidelines in 92.7 percent of cases. This number dropped to 83.7 percent on the patient's second visit.

Physicians reported that they prescribe antibiotics inappropriately because patients expect them, and “it is quicker to write a prescription than to explain why the antibiotics are not indicated,” Undeland said.

The Gundersen Lutheran Health System also offers a nurse-only triage and treatment algorithm for patients with pharyngitis. Appropriate antibiotic use jumped to 99.7 percent in patients who used this option.

Streptococcus infection is the primary reason to prescribe antibiotics for sore throat, according to Undeland. Approximately 5 to 10 percent of pharyngitis cases in adults and 15 to 30 percent of those in children are caused by streptococcus bacteria.

Antibiotic treatment can prevent complications such as rheumatic fever and kidney damage in these strep throat infections. Other bacterial causes of pharyngitis are much less common than strep throat.

Undeland reported that antibiotics were prescribed in 73 percent of adult sore throat cases between 1989 and 1999. This is much higher than the expected percentage of bacterial infections. Antibiotics are of no value in treating viral infections, and like all other drugs, carry the risk of side effects.

Penicillin treatment is effective at preventing complications of strep throat, Undeland noted. The Drugs.com web site lists side effects of penicillin, including diarrhea, fever, chills, bruising, reduced urination, skin rash, mental effects, and seizure.

The U. S. Library of Medicine's PubMed Health web site lists treatments to make a sore throat feel better, regardless of whether it's caused by bacteria or a virus:

1. Drink liquids, warm or cold.
2. Suck on throat lozenges or hard candy (not for young children).
3. Gargle with warm salt water, ½ teaspoon salt per cup of water.
4. Use a humidifier or vaporizer.
5. Try over-the-counter pain medications.


1. Undeland DK et al, “Appropriately prescribing antibiotics for patients with pharyngitis: A physician-based approach vs a nurse-only triage and treatment algorithm”, Mayo Clin Proc. 2010; 85(11): 1011-15.

2. Penicillin. Drugs.com. Web. Nov. 2, 2011.

3. U. S. Library of Medicine. PubMed Health. Pharyngitis. Web. Nov. 2, 2011.

Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.

Reviewed November 10, 2011
by Michele Blacksberg RN
Edited by Jody Smith

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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.



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