Date of this Version

October 2006

Document Type

Journal Article

Publication Details

Del Mar CB, Glasziou PP, Spinks AB. Antibiotics for sore throat. The Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD000023. DOI: 10.1002/14651858.CD000023.pub3.

This review is published as a Cochrane Review in The Cochrane Library 2007, Issue 2.
This version first published online: 18 October 2006 in Issue 4, 2006.
Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and The Cochrane Library should be consulted for the most recent version of the Review.
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at the Cochrane Library


2006 HERDC submission

Abstract

Background: Sore throat is a very 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 bene ts 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, Issue 1, 2006), MEDLINE (January 1966 to March 2006) and EMBASE (January 1990 to December 2005).

Selection criteria: Trials of antibiotic against control with either measures of the typical symptoms (throat soreness, headache or fever), or suppurative or non-suppurative complications of sore throat.

Data Collection and Analysis: Potential studies were screened independently by two authors for inclusion, with differences in opinion resolved by discussion. Data were then independently extracted from studies selected by inclusion by two authors. Researchers from three studies were contacted for additional information.

Main results: There were 27 studies with 2835 cases of sore throat.

1. Non-Suppurative Complications There was a trend for antibiotics to protect against acute glomerulonephritis, but there were insuf cient cases to be sure. Several studies found antibiotics reduced acute rheumatic fever by more than two thirds (relative risk (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); of acute sinusitis (RR 0.48; 95% CI 0.08 to 2.76); and of quinsy (peritonsillar abscess) compared to those taking placebo (RR 0.15; 95% CI 0.05 to 0.47).

3. Symptoms: Throat soreness and fever were reduced by antibiotics by about one half. The greatest difference was seen at about 3 to 4 days (when the symptoms of about 50% of untreated patients had settled). By one week about 90% of treated and untreated patients were symptom-free. The overall number need to treat to prevent one sore throat at day 3 was just under six (95% CI 4.9 to 7.0); at week 1 it was 21 (95% CI 13.2 to 47.9).

4. Subgroup Analyses Of Symptom Reduction: Analysis by: age; blind versus unblinded; or use of antipyretics, found no signi cant differences. Analysis of results of throat swabs showed that antibiotics were more effective against symptoms at day 3, RR 0.58 (95% CI 0.48 to 0.71) if the 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 bene ts in the treatment of sore throat. However, the absolute bene ts are modest. Protecting sore throat sufferers against suppurative and non-suppurative complications in modernWestern society can only be achieved by treating many with antibiotics, most of whom will derive no bene t. In emerging economies (where rates of acute rheumatic fever are high, for example), the number needed to treat may be much lower for antibiotics to be considered effective. Antibiotics shorten the duration of symptoms by about sixteen hours overall.

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