Antibiotics

Antibiotics are indicated in a small proportion of sore throats and have been shown to reduce the duration of symptoms by an average of 16 hours.  

Despite efforts to reduce usage in sore throats, they are prescribed to as many as 60 per cent of patients who attend general practice with a sore throat. The NICE guideline on antimicrobial prescribing includes a useful summary of their recommendations.

While pharmacists are authorised to make a NHS supply of antibiotics under the Pharmacy First scheme there is the opportunity to reduce their unnecessary use and reinforce antimicrobial stewardship. The use of clinical scoring systems and evidence-based communication techniques are key to appropriate use (see last month’s CPD module). 

NICE makes specific recommendations on which antibiotic to prescribe – normally this would be phenoxymethylpenicillin (penicillin-V), or clarithromycin in those with penicillin allergy.

Pharmacy First service-specific patient group directions define the inclusion and exclusion criteria for these antibiotics plus erythromycin (tablet and oral presentations).

The main contraindication is allergy or hypersensitivity to an antibiotic – usually penicillin. Those with a known allergy to phenoxymethylpenicillin, or any penicillin, or a history of severe immediate allergic reaction (e.g. anaphylaxis) to another beta-lactam antibiotic (e.g. cephalosporin, carbapenem or monobactam) must not be prescribed penicillin-V.

Acceptable sources of allergy information include the individual/carer/parent/guardian or the National Care Record. However, bear in mind that these sources are not always accurate.

Reflection exercise

What treatments will you recommend for sore throat? Compare notes with the members of your team and ensure that there Is consistency in explanations about evidence of effectiveness.