Inappropriate Antibiotic Prescribing for Sore Throat Remains High — Physician’s First Watch

Medical News |
October 4, 2013

Inappropriate Antibiotic Prescribing for Sore Throat Remains High

By Amy Orciari Herman

Antibiotics were prescribed in an estimated 60% of ambulatory sore throat visits across the U.S. from 1997 through 2010 — greatly exceeding the 10% of visits that should actually require penicillin — researchers report in JAMA Internal Medicine.

The researchers examined data on some 8200 adult visits for throat pain, representing an estimated 92 million visits nationwide during the study period. The antibiotic prescribing rate remained high throughout the study. Penicillin, the antibiotic of choice when treatment is required, was prescribed at 9% of visits. Azithromycin was prescribed increasingly, reaching 15% of visits by 2010.

The cost of unnecessary antibiotic prescribing was "conservatively" $500 million, the researchers estimate.

Paul Sax, an infectious diseases specialist with NEJM Journal Watch, said the findings emphasize "the seemingly intractable link that patients and providers have between sore throat and the need for antibiotics, with negative consequences both for the individual patient and to society."

Reader Comments (6)

CAROL VASSAR Physician, Internal Medicine, private practice

I entered private practice in 1990. In 2001 I had patient in her 40's who had a tonsilectomy for recurrent strep. Since then I have had 4 more middle aged patients with recurrent strep that ended up with tonsilectomies. My recollection is that I rarely found a positive strep test in the early years of practice. Fifteen years ago I was still a little surprised to find strep. Now it seems common. I attribute this to the crackdown on tonsillectomies 20 or 30 years ago and to having a patient population that does not some in for colds and other minor illnesses. 10% positive for strep sounds low for the number of patients with sore throat and tender lymph nodes. When was the figure of 10% determined? did those patients have tender cervical lymph nodes?

FLORIN RUPA Physician, Family Medicine/General Practice

What about the infections which require Macrolides
like Fusobacterium infections which are missed by swabs too

HENRY DE GIVE Physician, Pediatrics/Adolescent Medicine

The perils of practicing medicine by algorithm are amply clear to any physician who has taken care of an adolescent with tonsillitis caused by Fusobacterium necrophorum. These infections can cause complications such as thrombosis of the internal jugular and septic pulmonary emboli (Lemierre's Syndrome.) This is a rare and potentially fatal complication of untreated tonsillitis caused by a bacteria other than Group A streptococcus. Any recommendations for treating tonsillitis should include information about this disease.
While the goal of eradicating unnecessary antibiotic usage is admirable, the price of rigid adherence to clinical guideline may be fatal.

Jeffery Bandola MD Physician, Geriatrics, Rhode Island

Useful study, but no surprise.

What would surprise me would be the prohibition of the term "inappropriate" in all future medical writing. We would be forced to use actual terms of valuation, in this case "unnecessary," or perhaps "wrongful." Please, let's erase the word "inappropriate" from the medical lexicon. Then we can move on to scorn the use of the passive voice.

David Hager, M.D. Physician, Psychiatry

Assembly line agitato schedule, racing through the widgets like a Lewis Carroll white rabbit Unhappy patient wants to "know" something was done "My throat is sore ... fix it ... I'm paying you for this" Harried doc hates impotence ... and unhappy people Explaining diffuse global antibiotic resistance problems - "out there," beyond the walls of the office? Too time consuming.
And this patient has good reimbursement ... don't want to lose him.

Scribble, scribble, scribble.

Patient "wins." Doc "wins." Next patient, please!!

Bacteria win.

Hurry, hurry, hurry.
If only we could listen faster.
Same thing is happening in psychiatry.
Medication is a surrogate for meaningful interaction.

Dwight Michael, M.D. Physician, Family Medicine/General Practice, Gettysburg Family Practice, Inc., Gettysburg, Pa.

Helpful article but what is the present status of Fusobacterium nepcrophorum causing as many cases of pharyngitis as Group A strep and the potential for bad compications from this disease (i.e. Lemierre syndrome) as pointed out in your journal December 1, 2009 issue.

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