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Doctors Mishandling Sore Throat Treatment, Study Says

Often prescribe pricey antibiotics to treat a virus

TUESDAY, Sept. 11, 2001 (HealthDayNews) -- When you go to a doctor for a sore throat, the odds are that you will be given an antibiotic that not only will do nothing to fight the infection but also may be doing more harm than good, says a new study.

About 10 to 20 percent of the time, the sore throat will be due to a bacterial infection, usually a Streptococcus bacterium that causes the well-known "strep throat." The other 80 to 90 percent are caused by viruses, which aren't affected by antibiotics.

But analysis of 1989 to 1999 data from the National Ambulatory Medical Care Survey shows that 73 percent of sore throat patients were given prescriptions for antibiotics. And in two-thirds of those cases, patients didn't get the cheaper, old-line antibiotics that are effective for a strep throat but instead were given prescriptions for newer, expensive drugs that can increase bacterial antibiotic resistance.

One possible bright spot in this picture came in 1999, when just 57 percent of sore throat patients were prescribed antibiotics, the lowest figure for the decade. But it's not clear whether that represents a lasting change, says Dr. Jeffrey A. Linder, a research clinical professor at Massachusetts General Hospital in Boston and co-author of a report in the Sept. 12 Journal of the American Medical Association..

"We need to follow the numbers to see if the trend continues," says Linder.

He says more discouraging was a steady growth in use of advanced antibiotics, such as the fluoroquinolones and the macrolides, which are not recommended for strep throats. He says the most effective drugs remain two old standbys, penicillin and erythromycin. The newer drugs cost 20 to 40 times more than the old ones and pose a long-term problem. Strep bacteria are developing resistance to the newer antibiotics while, for unknown reasons, they have never become resistant to either penicillin or erythromycin.

So why do doctors prescribe the more expensive drugs? "One reason is that there is a promotional push behind the newer antibiotics that doesn't exist for the older ones," Linder says. There's a psychological reason as well, he says: "Doctors and patients feel they want to use the stronger antibiotics that are appropriate for serious infections. But they are not appropriate for a strep throat."

Linder says doctors should first assess a patient's symptoms to see if they indicate a strep infection and then run an in-office test, which can be done in 10 to 20 minutes, to confirm a strep throat.

Most doctors don't follow that routine because of time pressure, says study co-author Dr. Randall S. Stafford, assistant professor of medicine at the Stanford Center for Research in Disease Prevention in California.

Stafford says, "Physician knowledge isn't really the problem, but many physicians feel trapped. They know the right thing to do is to not prescribe antibiotics or to choose the right antibiotics if it is a strep throat. But the time demands of a practice, which I felt in my own experience as a primary-care physician, militate against that. It takes longer not only to run the test but also to explain to the patient why antibiotics may not be necessary. So some physicians end up making the decision to provide an antibiotic because they feel they have no choice."

The study found that antibiotics are more likely to be prescribed by older doctors who can remember when a sore throat could lead to rheumatic heart fever, a dangerous condition that eventually can require surgery. But Stafford says that risk has dropped considerably over the decades. "It takes three physician lifetimes to see one case of rheumatic fever. The consensus now is that the risk of unneeded antibiotics outweigh the risk of rheumatic fever," Stafford says.

What To Do

Patients can help solve the doctor's dilemma by bearing up with a sore throat, Stafford says. "We need some recognition that many sore throats are self-limiting, and going to a doctor's office is unlikely to provide benefits beyond what a patient gets from self- treatment."

A primer on sore throats is offered at the Achoo Web site. To learn more about antibiotic resistance, visit the Centers for Disease Control and Prevention.

SOURCES: Interviews with Jeffrey A. Linder, M.D., research clinical fellow, Massachusetts General Hospital, Boston, and Randall S. Stafford, M.D., Ph.D., assistant professor of medicine, Stanford Center for Research in Disease Prevention, Palo Alto, Calif.; Sept 12, 2001, Journal of the American Medical Association
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