November 24, 2014
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Study: Antibiotics overprescribed for kids' sore throats

Your child's doctor should do more than just make them say "Ah" before prescribing antibiotics to treat a sore throat, says a study in the Journal of the American Medical Association.

According to the study, doctors are prescribing antibiotics for children's sore throats more frequently than is necessary.

Researchers at Brigham and Women's Hospital and Harvard Medical School compared the rate of antibiotic prescriptions for sore throats to the rate of testing for group A B-hemolytic streptococci (GABHS) or strep throat, the only common cause of sore throats which can be treated with antibiotics. These bacteria are responsible for 15% to 36% of sore throats in children, the study's authors note.

The researchers used data collected from 1995 to 2003 as part of the US National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, which included information from 4,158 sets of medical records on children between the ages of 3 and 17 across the US who had visited a doctor, clinic or emergency room with the chief complaint of a sore throat. As data on strep testing was only included in the survey from 1997 on, only 2,797 of the records included this information.

Using medical records from the surveys, the researchers identified children who had been prescribed antibiotics used to treat strep throat as well as cases where doctors had tested for strep.

During the study period, an estimated 66 million children sought medical care for a sore throat, an average of 7.3 million per year. Antibiotics were prescribed in 53% of those visits, and in 14% of cases, the antibiotic that was prescribed was not one recommended for treating strep.

In records where the performance of a strep test was recorded, the test was conducted in 53% of visits. Antibiotics were prescribed in 48% of visits where doctors tested for strep and 51% of visits where no test was administered. A statistical analysis found no association between testing and the likelihood of receiving a prescription for antibiotics.

But there was some good news.

"Encouragingly, we found a significant decrease in the proportion of patients receiving antibiotics over the study period," wrote Dr. Jeffrey A. Linder and colleagues. "However, even at the end of the study period, the proportion of children prescribed an antibiotic still exceeded the maximum expected prevalence of GABHS among children with sore throat."

Dangers of prescribing unnecessary antibiotics include increasing the prevalence of drug-resistant bacteria as well as the possibility of adverse reactions to the prescribed medication.

In order to cut the rate of unnecessary antibiotic use in children, the researchers recommend testing children who are likely to have strep throat and not just a cold or other virus before prescribing antibiotics, and treating the pain of a sore throat with acetaminophen or ibuprofen.

According to the authors, symptoms of a cold or other viral infection include coughing, sniffles, hoarseness and pinkeye, while strep may be accompanied by a fever, headache, painful swallowing, abdominal pain, nausea, vomiting, headache or tender lymph nodes.


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