Docs Giving Wrong Rx to Kids with Sore Throats

For years, there has been concern that antibiotics are
overprescribed, and with good cause. Despite clear
guidelines calling for prior testing, physicians prescribed
antibiotics in 53 percent of sore throat cases in children,
researchers from Brigham and Women's Hospital (BWH) and
Children's Hospital Boston found in a recent study.

This represents significantly more prescriptions than
warranted for actual rates -- 15-36 percent -- of strep
throat among kids with sore throat. Furthermore, almost
half of those prescriptions were given in the absence of a
test. Details of this research appear in the November 9,
2005, issue of the Journal of the American Medical
Association.

Group A streptococcal pharyngitis, or strep throat, is the
most common cause of sore throat for which antibiotics are
indicated. However, many leading health organizations,
including the Centers for Disease Control and Prevention
and the American Academy of Pediatrics say that a common
"strep" test should be performed prior to prescribing
recommended antibiotics.

Antibiotic-Resistant Bacteria

"This study demonstrates that children with sore throat are
frequently given unnecessary antibiotics," says lead author
Jeffrey A. Linder, MD, MPH, a BWH internist.

"This overprescribing of antibiotics could be easily
remedied by following known guidelines, which include doing
a simple, inexpensive strep test," he adds.

"This is critical for not just children but all patients,"
Dr. Linder notes, "as unnecessary prescription of
antibiotics can lead to a variety of issues, including
increased costs, the potential development of
antibiotic-resistant bacteria, and adverse drug effects."

Researchers analyzed data from children aged 3 to 17 years
from 1995 to 2003 with sore throat who visited office-based
physicians, hospital outpatient departments and emergency
departments.

Among an estimated 7.3 million visits for sore throat over
this time period, physicians prescribed antibiotics in 53
percent of the cases, the researchers found.

Just 15 to 36 percent of children with sore throat actually
have the strep throat bacterium, according to estimates.
But only 53 percent of those who were given the antibiotics
had been tested first.

Testing Is Underused

Over the eight-year time period of the study, physicians
prescribed antibiotics less frequently, the researchers
found, which suggests an encouraging trend. In 1995, 66
percent of cases were given antibiotics, decreasing to 54
percent of cases in 2003.

Still, there was no decrease in the prescribing of
non-recommended antibiotics, which made up 27 percent of
antibiotic prescriptions, Dr. Linder points out.
Recommended antibiotics for the treatment of strep throat
are penicillin, amoxicillin, erythromycin and
first-generation cephalosporins.

"Strep testing is underused, and physicians should be
ordering this important diagnostic test before prescribing
antibiotics to kids with sore throat," emphasizes Dr.
Linder.

"Instead of writing a prescription, physicians should order
a test and make sure they are treating kids' symptoms by
offering a pain medication like acetaminophen or
ibuprofen," he advises.

Copyright 2005 Daily News Central