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Children Overprescribed Antibiotics for Sore Throat

CHICAGO, IL -- November 8, 2005 -- Physicians prescribe antibiotics for more than half of children with sore throat, exceeding the expected prevalence of strep throat, and used nonrecommended antibiotics for 27% of children who received an antibiotic prescription, according to a study in the November 9 issue of JAMA.

Pharyngitis accounts for 6% of visits by children to family medicine physicians and pediatricians, according to background information in the article. The most common manifestation of acute pharyngitis is sore throat. The main bacterial cause of sore throat and the only common cause of sore throat warranting antibiotic treatment is group A beta-hemolytic streptococci (GABHS). GABHS are cultured from 15% to 36% of children with sore throat.

To improve diagnostic accuracy and reduce unnecessary antibiotic treatment, it is recommended that a GABHS test be conducted prior to treating children with an antibiotic. Penicillin is the recommended antibiotic, but acceptable alternatives include amoxicillin, erythromycin (for penicillin-allergic patients), and first-generation cephalosporins.

Jeffrey A. Linder, MD, MPH, of Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues conducted a study to determine the change in the rate and type of antibiotics prescribed to children with a chief complaint of sore throat, and the frequency of GABHS testing.

The researchers used data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from 1995 to 2003. The study included an analysis of visits by children aged 3 to 17 years with sore throat to office-based physicians, hospital outpatient departments, and emergency departments (n=4,158), and of a subset of visits with GABHS testing data (n=2,797).

The researchers found that physicians prescribed antibiotics in 53% of an estimated 7.3 million annual visits for sore throat and nonrecommended antibiotics to 27% of children who received an antibiotic. Antibiotic prescribing decreased from 66% of visits in 1995 to 54% of visits in 2003. This decrease was attributable to a decrease in the prescribing of recommended antibiotics (49% to 38%).

Physicians performed a GABHS test in 53% of visits and in 51% of visits at which an antibiotic was prescribed. GABHS testing was not associated with a lower antibiotic prescribing rate overall (48% tested vs. 51% not tested), but testing was associated with a lower antibiotic prescribing rate for children with diagnosis codes for pharyngitis, tonsillitis, and streptococcal sore throat (57% tested vs. 73% not tested).

"In conclusion, we found that physicians prescribed antibiotics less frequently over time to children with sore throat. However, the overall antibiotic prescribing rate continues to exceed the expected prevalence of GABHS, and physicians continue to select unnecessarily broad-spectrum antibiotics.

Unnecessary antibiotic prescriptions are not benign: they increase the prevalence of antibiotic-resistant bacteria, expose patients to adverse drug events, and increase costs. Perhaps unique among upper respiratory tract infections, clinicians have good, objective criteria in the form of GABHS testing to guide the antibiotic treatment of children with sore throat. Limiting antibiotic prescribing to children with a positive GABHS test result is a feasible goal for primary care physicians and an important step toward judicious use of antibiotics overall," the authors write.

This study was supported by the Agency for Healthcare Research and Quality through a Career Development Award to Dr. Linder. Co-author Grace M. Lee, MD, MPH, is supported by an Agency for Healthcare Research and Quality Career Development Award.

JAMA.2005; 294:2315-2322.


SOURCE: American Medical Association

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