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. Yet studies in general practice have found there is often a mismatch between what the GP thinks the patient wants and what the patient actually wants.

Where community pharmacists are authorised to make a NHS supply of antibiotics there is the opportunity to reduce their unnecessary use and reinforce antimicrobial stewardship. Where the decision is not to give an antibiotic there is good evidence that many patients are satisfied if listened to carefully, examined thoroughly and provided with an explanation, with alternatives recommended for relieving symptoms. 

NICE makes specific recommendations on which antibiotic to prescribe – normally this would be phenoxymethylpenicillin (penicillin-V), or clarithromycin in those with penicillin allergy. See: nice.org.uk/guidance/ng84/chapter/Recommendations #managing-acute-sore-throat. Service-specific Patient Group Directions (PGDs) define the inclusion and exclusion criteria for different antibiotics.

The main contraindication is allergy/hypersensitivity to an antibiotic – usually penicillin. Those with a known allergy to phenoxymethylpenicillin (penicillin V), 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 individual/carer/parent/guardian or the National Care Record (but bear in mind these sources are not always accurate).

References

1. bmjopen.bmj.com/content/12/4/e055464