September 21, 2001

Most adult patients who see their doctors for a sore throat receive a prescription for an antibiotic, despite the fact that antibiotic treatment may be appropriate for only 10 percent of such patients. And even though traditional antibiotics penicillin and erythromycin are the recommended treatment for sore throats that do require antibiotics, physicians often prescribe newer, more expensive "broad-spectrum" antibiotics instead. These findings, based upon research conducted at the MGH, appeared in the Sept. 12 issue of the Journal of the American Medical Association.

The vast majority of sore throats are caused by viral infection, which antibiotics do not treat. Only in cases of bacterial infection – commonly referred to as "strep throat" – can antibiotics be useful. The current study, which analyzed physician practices from 1989 through 1999, supports previous research finding excessive antibiotic use in sore throats, and is the first to delineate the trend of prescribing inappropriate classes of the medications.

"There are pretty well-known criteria for diagnosing strep throat and predicting its incidence in a population," says Jeffrey Linder, MD, of the MGH General Medicine Division, the paper's first author. "If you go in to see your doctor for an upper respiratory infection – including a sore throat – nine times out of ten, you should not be given an antibiotic."

Linder and senior author Randall Stafford, MD, PhD (who now is at Stanford University), analyzed data from an annual survey of physicians who answered questions about patients' diagnoses and the treatments provided after outpatient visits during a certain week. Among patients seen for sore throats during the study period, 73 percent received an antibiotic prescription. Of those prescriptions, 68 percent were not for one of the two recommended antibiotics.

While the dangers of overusing antibiotics – most significantly, the development of antibiotic resistance in bacteria – are well known, there are many forces that could lead physicians to prescribe them inappropriately. Antibiotic use also may needlessly place patients at risk for allergic reactions, and the newer antibiotics can be as much as 20 to 40 times more expensive than penicillin or erythromycin.