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Children overprescribed antibiotics for sore throat

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 percent of children who received an antibiotic prescription, according to a study in the November 9 issue of JAMA.

Pharyngitis (inflammation of the throat) accounts for 6 percent 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 percent to 36 percent 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, M.D., M.P.H., 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 (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) 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 percent of an estimated 7.3 million annual visits for
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Source:JAMA and Archives Journals


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