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Antibiotics: Overused for Sore Throats?

Many Kids Are Getting Antibiotic Treatments When They Don't Have Strep Throat
WebMD Health News
Reviewed by Louise Chang, MD

Nov. 8, 2005 - Antibiotics are still being overprescribed to children with sore throats, and kids who do need them are often given the wrong ones, a new study shows.

It is estimated that at most about a third of children who are treated by physicians for sore throats actually have strep throat, with some studies suggesting that as few as 15% have the bacterial infection.

Although many people might refer to any sore throat as "strep throat," a true strep throat is one caused by infection from streptococci bacteria.

Antibiotics were prescribed to more than half of the children in the new study, published in the Nov. 9 issue of The Journal of the American Medical Association.

And roughly one in four prescriptions involved antibiotics other than those recommended, potentially increasing the risk for treatment failure and future drug resistance.

Not All Bad News

The findings are somewhat discouraging in light of aggressive efforts to educate physicians and the public about the dangers of antibiotic overuse, the study's researcher tells WebMD.

But he added that there is also reason for optimism. The total number of antibiotic prescriptions written for children with sore throats fell from 66% in 1995 to 53% in 2003.

"The overall trend is down, but clearly there are still too many antibiotics being prescribed," says Jeffrey A. Linder, MD, MPH, of Brigham and Women's Hospital and Harvard Medical School.

Linder and colleagues analyzed data from two national medical care surveys that included information on roughly 7,000 pediatric visits to physicians for sore throats.

Kids and Strep Tests

The researchers found that a test that confirms strep throat was given only about half the time and seemed to have no impact on whether physicians prescribed antibiotics or not.

"All kids should be given a strep test before they are treated with antibiotics," Linder says.

But that doesn't mean that every child who sees the doctor for a sore throat needs a strep test, he adds. If other symptoms indicate a cold or other viral infection no test may be needed.

Linder notes that symptoms not suggestive of strep throat include:

  • Sniffles or runny nose
  • Cough
  • Hoarse voice
  • Pink eye
  • Diarrhea

Symptoms, other than sore throat, that suggest strep throat include:

  • High fever
  • Sudden onset of symptoms
  • Abdominal pain
  • Nausea and vomiting
  • Headache
  • Tender lymph nodes in the neck

"It isn't always clear with kids, though, and that is why testing is so important if there is any question," he says.

The Wrong Drugs

The world's first antibiotic remains the drug of choice for the treatment of children with strep throat. Leading pediatric and infectious disease groups, including the CDC, recommend penicillin whenever possible. Acceptable alternatives include three other long-relied on antibiotics -- amoxicillin, erythromycin, and first-generation cephalosporins.

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