Antibiotics for sore throat

Spinks A, Glasziou PP, Del Mar C

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Summary

Antibiotics for people with sore throats

Sore throats are infections caused by bacteria or viruses. People usually recover quickly (usually after three or four days), although some develop complications. A serious but rare complication is rheumatic fever, which affects the heart and joints. Antibiotics reduce bacterial infections, but they can cause diarrhoea, rash and other adverse effects, and communities build resistance to them. This review of trials found that antibiotics shorten the illness by an average of about one day and can reduce the chance of rheumatic fever in communities where this complication is common.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Spinks A, Glasziou PP, Del Mar C. Antibiotics for sore throat. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD000023. DOI: 10.1002/14651858.CD000023.pub3.

This version first published online: July 21. 1997
Last assessed as up-to-date: November 25. 2008

Abstract

Background

Sore throat is a common reason for people to present for medical care. Although it remits spontaneously, primary care doctors commonly prescribe antibiotics for it.

Objectives

To assess the benefits of antibiotics for sore throat.

Search strategy

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library, 2008, issue 4) which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (January 1966 to November 2008) and EMBASE (January 1990 to November 2008).

Selection criteria

Trials of antibiotic against control with either measures of typical symptoms, or suppurative or non-suppurative complications.

Data collection and analysis

Two review authors independently screened studies for inclusion and extracted data. Differences in opinion were resolved by discussion. Researchers from three studies were contacted for additional information.

Main results

There were 27 studies with 12,835 cases of sore throat.

1. Non-suppurative complications
The trend was antibiotics protecting against acute glomerulonephritis but there were too few cases to be sure. Several studies found antibiotics reduced acute rheumatic fever by more than two thirds (risk ratio (RR) 0.22; 95% CI 0.02 to 2.08).

2. Suppurative complications
Antibiotics reduced the incidence of acute otitis media (RR 0.30; 95% CI 0.15 to 0.58); acute sinusitis (RR 0.48; 95% CI 0.08 to 2.76); and quinsy (RR 0.15; 95% CI 0.05 to 0.47) compared to those taking placebo.

3. Symptoms
Throat soreness and fever were reduced using antibiotics by about half. The greatest difference was seen at Day 3. The number needed to treat (NNT) to prevent one sore throat at Day 3 was less than six; at Week 1 it was 21.

4. Subgroup analyses of symptom reduction
Antibiotics were more effective against symptoms at Day 3 (RR 0.58; 95% CI 0.48 to 0.71) if throat swabs were positive for Streptococcus, compared to RR 0.78; 95% CI 0.63 to 0.97 if negative. Similarly at week 1, RRs 0.29; 95% CI 0.12 to 0.70 for positive, and 0.73; 95% CI 0.50 to 1.07 for negative swabs.

Authors' conclusions

Antibiotics confer relative benefits in the treatment of sore throat. However, the absolute benefits are modest. Protecting sore throat sufferers against suppurative and non-suppurative complications in high-income countries requires treating many with antibiotics for one to benefit. This NNT may be lower in low-income countries. Antibiotics shorten the duration of symptoms by about 16 hours overall.

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