Penicillin No Panacea for Sore Throat in Kids

Symptom severity, duration not reduced, study finds

THURSDAY, Dec. 4, 2003 (HealthDayNews) -- Giving antibiotics to a child with a severe sore throat hardly ever does any good, says a Dutch physician who led what is believed to be the first carefully controlled study of the treatment.

Sore throat symptoms were just as bad and lasted just as long in children given penicillin as those given a placebo, says a report in the Dec. 6 issue of the British Medical Journal.

The study shows "it would be rare indeed" for a child with a sore threat to benefit from antibiotic treatment, says Dr. Sjoerd Zwart, a general practitioner at the Julius Center for Health Sciences and Primary Care of University Medical Center Utrecht, who led the trial.

Zwart estimates that only one child in 20 with symptoms severe enough to warrant a visit to a physician would be helped by antibiotic therapy.

His estimate is based on a trial in which 156 children who came to family physicians with sore throats were divided into three groups. One group got penicillin for seven days, a second got penicillin for three days followed by a placebo for four days, and the third got a placebo only.

Penicillin is given to fight sore throats caused by Streptococcus bacteria rather than a virus. But "penicillin treatment was not more beneficial in resolving symptoms of sore throat, neither in the total group nor in the 96 children with group A Streptococci," says the journal report.

Zwart says he would reserve antibiotic treatment for children in whom the sore throat is severe enough to raise the possibility of sequelae, complications that can cause lasting damage. That stance is in line with Dutch guidelines, he notes, but those guidelines have been based on observational reports. This scientifically controlled study provides more solid evidence, Zwart says.

Doctors now often prescribe antibiotics because they believe parents want them for their children, he says. "But what we see if we listen carefully to the parents, their concern is that the health of the child be guaranteed," he says. "If we can make that guarantee with our professional expertise, parents are more willing to take their child home without antibiotics."

But an American family doctor who deals with the issue every day in his practice takes a different attitude. Dr. Michael O. Fleming, president of the American Academy of Family Physicians, says that in his experience, "When parents bring in a child with an ear infection, you can reassure them all you want, but they will still demand antibiotics." The same holds true for sore throats, Fleming says.

"If a child is ill and I am convinced from a physical evaluation that antibiotic therapy will help, I tend to do it," he says. "Even though the risk of sequelae is low, even if one occurs, that is too much."

Nevertheless, Fleming says he will prescribe an antibiotic only if the sore throat is caused by a streptococcal infection. "I don't treat children with what appears to be a viral infection with antibiotics, even if the parents insist," he says. For a child with signs of a streptococcal infection, "it would take a lot of convincing for me not to respond with antibiotics," Fleming says.

But there is room for a change in attitude, if future controlled studies give similar results, he says. The Dutch trial "opens a very, very interesting area for study," Fleming says.

More information

You can learn about sore throat, its causes and treatment, from the National Library of Medicine or the American Academy of Family Physicians.

SOURCES: Sjoerd Zwart, M.D., general practitioner, University Medical Center Utrecht, The Netherlands; Michael O. Fleming, M.D., family physician, Shreveport, La.; Dec. 6, 2003, British Medical Journal
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