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Use of Nonrecommended Antibiotics in Sore Throats Is Increasing

Only 17 percent, at most, of pharyngitis in adults is caused by group A ß-hemolytic streptococci; in the remainder of pharyngitis cases, antibiotics generally are not indicated. In this study, investigators used data from the National Ambulatory Medical Care Survey to assess antibiotic use in adults with sore throat. Included in this analysis were 2244 adult visits (from 1989 through 1999) to primary care physicians, in which the chief complaints were sore throats.

Antibiotics were prescribed during 73 percent of visits; in two thirds of these visits (49 percent of all visits), the drugs were nonrecommended antibiotics (e.g., cephalosporins, floroquinolones, or extended-release macrolides). Use of recommended antibiotics (penicillin or erythromycin) decreased significantly during the 11-year study, from 32 percent to 11 percent of visits. Total antibiotic use, however, declined only slightly (although significantly), because use of nonrecommended antibiotics increased over time, from about 40 percent of visits to more than 50 percent. Family physicians were more likely than internists to prescribe antibiotics overall, but internists were more likely to prescribe nonrecommended antibiotics.

Comment: Pharyngitis accounts for 9 percent of all antibiotic use in adults, of which most appears to be unnecessary. The predominant use of nonrecommended antibiotics is expensive and may contribute to increasing bacterial resistance.

— TL Schwenk

Published in Journal Watch General Medicine October 5, 2001

Citation(s):

Linder JA and Stafford RS. Antibiotic treatment of adults with sore throat by community primary care physicians: A national survey, 1989–1999. JAMA 2001 Sep 12 286 1181-1186.

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