Research Activities, March 2014
Little improvement in antibiotic prescribing for adults visiting the doctor for sore throats
Patient Safety and Quality of Care
Adults with sore throats accounted for a significantly smaller proportion of visits to primary care providers (PCPs) in 2010 than in 1997 (4.3 percent vs. 7.5 percent of all primary care visits, respectively). In contrast, adults with sore throat made up 2.3 percent of walk-in patients at emergency departments in 2010, virtually unchanged from the 2.2 percent in 1997, according to a new study. Antibiotics are unlikely to be beneficial in most cases of throat inflammation in adults. Apart from the 10 percent of sore throats caused by group A streptococcal infections, few respond to antibiotics. Penicillin is recommended as first-line treatment for streptococcal sore throat. In contrast, the use of expensive, broad-spectrum antibiotics may increase the prevalence of antibiotic-resistant bacteria and the cost of care.
Michael L. Barnett, M.D., and Jeffrey A. Linder, M.D., M.P.H., of Brigham and Women's Hospital in Boston previously reported that the proportion of adults seeking care for sore throat for whom antibiotics were prescribed fell from 80 percent to 70 percent around 1993.
Now they have found that the proportion of adult ambulatory care patients who received an antibiotic prescription for sore throat remained relatively stable during the period from 1997 through 2010, only falling to 60 percent of visits to PCPs by 2010. In addition, the use of penicillin remained stable during the period at 9 percent of the visits, while the use of azithromycin, an antibiotic that targets a broad spectrum of bacteria, increased from below a measurable threshold in 1997–1998 to 15 percent by 2010.
The findings were based on data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. The study was funded in part by AHRQ (HS18419).
More details are in "Antibiotic prescribing to adults with sore throat in the United States. 1997–2010," by Drs. Barnett and Linder, in the January 2014 JAMA Internal Medicine 174(1), pp. 138-140.