Sore throats account for 6% of pediatrician office visits. Approximately 15% to 36% of sore throats are caused by a streptococcus ( strep ) bacteria, which can be successfully treated with antibiotics. But the majority of sore throats are caused by respiratory viruses, which do not respond to antibiotics. Because overprescribing antibiotics can lead to resistance of bacteria, the American Academy of Pediatrics (AAP), Centers for Disease Control and Prevention (CDC), and Infectious Diseases Society of America (IDSA) recommend that physicians perform a strep test in children with sore throats to determine whether antibiotic treatment is appropriate.

A new study in the November 9, 2005 issue of the Journal of the American Medical Association found that physicians prescribed antibiotics to 53% of children with sore throats, which is in excess of the number of children expected to have sore throats caused by the strep bacteria.

About the Study

This study included 4,158 records of children’s visits to healthcare providers from 1995 through 2003. The children were ages 3-17 and were visiting a healthcare provider because of a sore throat. They had no other condition that could be treated with antibiotics. The researchers determined how often antibiotics were prescribed; whether the antibiotics were among those recommended for strep infections by the AAP, CDC, and IDSA; and whether strep testing was performed.

Physicians prescribed antibiotics to 53% of the participants. In 27% of these cases, the antibiotics were not among those recommended by the AAP, CDC, and IDSA. Antibiotic prescribing decreased over time, from 66% of visits in 1995 to 54% in 2003. A strep test was performed in 53% of visits, with no change over time. Whether or not strep testing was performed, physicians continued to prescribe antibiotics about half of the time.

This study was limited because the data did not include the results of the strep test, so the researchers could not determine whether the antibiotics were prescribed appropriately or not.

How Does This Affect You?

These findings suggest that despite national recommendations to the contrary, physicians are likely overprescribing antibiotics to children with sore throats. It is important for physicians to perform strep testing in children likely to have a strep infection—those older than three with a sore throat, fever, headache, and painful swallowing. Children who have symptoms of viral infections (e.g., congestion, hoarseness, cough) are not likely to have a bacterial infection and should not be treated with antibiotics.

Most children with sore throats are suffering from a viral infection that will not respond to antibiotics. When used unnecessarily, antibiotics can even be harmful, since they can increase bacterial resistance to antibiotics, making it harder to treat a bacterial infection when it does occur. If your child has a sore throat, it is still best to consult your physician. If he or she believes your child’s sore throat is caused by a bacterial infection, ask about a strep test. If your child requires antibiotics, it is important that he or she takes the full course (usually 10 days) to avoid recurrence or resistance.