Do I Need Antibiotics For A Sore Throat?

Mint Tea in White TeacupPhoto attribution: Mint by T.Moe (Flickr)

Flu season is coming up, what should you do when you start to feel a tickle in your throat, let alone when your throat feels like it is on fire? Do you need antibiotics for a sore throat? Many of us pick up the phone to call our doctors when we start to feel sick, but is this necessary? Probably not.

A recent JAMA article explained that while only 10% of sore throats are due to Group A Strep (the only type of sore throat that needs antibiotics), a massive 60% of patients who see doctors with this complaint are sent home with an unnecessary prescription for antibiotics.

Why not just take the antibiotic? Several reasons exist.

  1. Antibiotics won’t help the common sore throat because that sore throat is probably from a virus, which doesn’t respond to antibiotics
  2. 25% of people experience diarrhea from antibiotics – if you can avoid diarrhea, wouldn’t you?
  3. Rarely people will have serious adverse reactions from antibiotics, often requiring at least an ER visit if not a brief hospitalization
  4. There is a global health crisis of antibiotic resistant-bacterial infections, which are potentially deadly and have no effective cure. Each antibiotic prescription filled increases the chance of such bugs developing over time.

So, why DO doctors write so many prescriptions for sore throats given that most are viral in nature? The concern is in missing a true bacterial Group A Streptococcus (aka strep) infection, which may rarely (RARELY) lead to acute rheumatic fever.

In medical school, we were all taught to fear rheumatic fever, but in reality it is a very rare sequelae of strep infections. The CDC sends bulletins routinely starting in early Fall reminding doctors to pause before writing antibiotics given the facts above, yet it appears many doctors continue to write antibiotics without significant second thought.

But, I don’t want strep …

Viral infections that cause a sore throat will most likely self-resolve within 3-4 days. Rather than reflexively calling your doctor when you start to feel sick, consider first if your symptoms warrant a throat culture and antibiotics. How does one make such a determination? By using the same criteria and scale that your doctor would most likely use:

The Centor Criteria:

(Give yourself 1 point for each positive answer)

  • Fever
  • Tonsillar exudates (white spots on the tonsils)
  • NO cough
  • Tender Lymph Nodes on the front and sides of the neck
  • Age <15
  • Age >44 (subtract a point)

Tally your points:

  • 0-1: no strep, no antibiotics needed: no need to see your doctor
  • 2-3: go see your doctor and ask for a throat culture (score of 2: 15% chance of strep;  score, of 3: 32% chance of strep)
  • 4-5: see your doctor, no question (56% chance of strep)

Depending on your score, your doctor may empirically treat with antibiotics, or may choose to get a culture first then treat if needed.

If your score is low, relax, consider taking a sick day, drink some hot lemon (hot water with lemon and honey), and spend the day recuperating.

Use your judgment always. If you feel you should call your doctor, please do regardless of your score.

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