Antibiotics Still Overprescribed for Sore Throat

A new study finds that, since 2000, approximately 6 in 10 adults with sore throat have been prescribed antibiotics, in most cases unnecessarily.

Despite efforts to reduce rates of antibiotic prescribing for adults with sore throats, a new study finds that only minor improvements have been made in recent years.

Previous research has found that the antibiotic prescribing rate for adults visiting primary care practices or the emergency department for a sore throat decreased to approximately 70% in 1993. To calculate the antibiotic prescribing rate since then, the current study, published online on October 3, 2013, in JAMA Internal Medicine, used data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. Both surveys are conducted annually, are nationally representative, and collect information on physicians and practices, patient demographics, diagnoses, and prescriptions written at ambulatory visits in the United States.

The researchers studied adults aged 18 and older who visited a primary care physician or an emergency department for a sore throat from 1997 to 2010. Patients with injuries, immunosuppression, or additional infectious diagnoses were excluded from the study. Antibiotics given to patients were identified and classified as penicillin, amoxicillin, erythromycin, azithromycin, other second-line antibiotics, and all other antibiotics.

A total of 8191 sore throat visits were included in the study, representing an estimated 92 million visits nationally over the entire period covered by the study. Sore throat visits decreased from 7.5% of all primary care visits in 1997 to 4.3% of visits in 2010. The portion of emergency room visits that were for sore throat did not change significantly during the study period—it was 2.2% in 1997 and 2.3% in 2010. Antibiotic prescribing rates for adults with sore throat dropped to 60% in 2000 and remained stable from then until 2010. Although the researchers did not have data to determine whether a given prescription for antibiotics was appropriate, they note that the portion of sore throat patients who are prescribed antibiotics continues to greatly exceed the 10% of adults with sore throats who present with the only common cause of sore throat requiring antibiotics—group A Streptococcus infections.

Prescribing rates for penicillin, which is inexpensive, well-tolerated, and recommended to treat these infections, remained relatively low, accounting for just 9% of antibiotics prescribed during the study period. However, prescription rates for more expensive, broader-spectrum antibiotics increased. For example, in 1997 to 1998, prescription rates for azithromycin were too low to be measured accurately, but in 2009 to 2010, azithromycin constituted 15% of antibiotics prescribed.

Despite the modest improvement in antibiotic prescription rates for sore throat, the authors warn that in cases in which they are unneeded, antibiotics are likely to cause more problems than they solve.

“Antibiotic prescribing to patients who are unlikely to benefit is not benign,” the researchers conclude. “All antibiotic prescribing increases the prevalence of antibiotic-resistant bacteria.”