Sore throat? Don’t expect antibiotics

Doctors still frequently prescribe antibiotics for ‘strep throat’ – without using an extended consultation that may indicate a viral infection rather than a bacterial one, a new study has found.

Community GPs and primary care doctors under pressure to reduce antibiotic prescriptions can regularly use a simple consulting metric to help patients deal with a sore throat, the Flinders University researchers say.

Flinders University researcher Dr Chirag Patel, a primary care physician, is lead author of a paper asking: Can the use of Modified Centor Criteria (MCC) reduce antibiotic prescribing?

He says the MCC criteria is a simple score that takes into account the age of the patient, the presence of swollen tonsils with or without pus, tender/swollen anterior cervical lymph nodes, a fever of above 38°C, and whether a cough is present or not.

“Even if all the criteria were present, the probability of this being a Strep A infection is still only 53%,” he says.

Just under 50% of consultation notes collected between 2015-16 demonstrated full documentation of the MCC criteria.

“We found if all components were recorded in the patient notes then they would be less likely to get antibiotics,” says Dr Patel, whose recent article argues that thorough and full documentation lead to better decision-making.

Published in the Australian Journal of General Practice, the study found that out of 1761 patient consultations in two rural clinics in South Australia, more than 80% were prescribed antibiotics for tonsillitis, pharyngitis or tonsillopharyngitis.

While it’s difficult to tell whether the case is caused by a virus or strep A infection, Australian doctors still regularly prescribe antibiotics for the debilitating tonsillopharyngitis without thorough assessments.

Medical systems are facing rising fatalities as antibiotic resistance causes the rise of superbugs.

The researchers also point to the overuse of prescribing antibiotics in low-risk populations where complications from throat infections are unlikely to lead to more serious illnesses.

“Antibiotics are prescribed to reduce complications of the strep A infection, but a western society is usually a low risk population where the complication rate is very, very low,” Dr Patel says.

In western countries, there are many options for managing bacterial throat infections, the researchers say, starting with a checklist which produces the “modified Centor criteria” score which can be used in low-risk patients aged 3-64 years of age.

The article, ‘Antibiotic prescribing for tonsillopharyngitis in a general practice setting (Can the use of Modified Centor Criteria reduce antibiotic prescribing)’ 2019 by Chirag Patel, Benjamin Daniel Green, Jacynta May Batt, Feruza Kholmurodova, Mary Barnes, William Jude Geyer and Jill Benson was published by the Royal Australian College of General Practitioners (RACGP).

The paper recommended management guidelines specifically for this group of infections in the RACGP’s current portfolio of guidance for GPs. Education programs such as this, and investigations into whether lab testing reduces antibiotic prescribing in general practice could also be warranted

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