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Antibiotic use in the emergency department for acute sore throat

02 June 2024
Volume 6 · Issue 6


Acute sore throat is a frequent cause of inappropriate antibiotic prescribing in primary care, despite the majority of cases being viral in nature. Following changes in consulting behaviour, many patients are now turning to emergency departments for their primary care needs. The aim of this study was to determine whether clinical scores are used between staff groups when treating acute tonsillitis in an emergency department and whether antibiotics are prescribed appropriately. A retrospective service evaluation of patients diagnosed with ‘tonsillitis’ in the emergency department over a 12-month period was conducted. Patient records were reviewed for Centor or FeverPAIN scoring documentation, antibiotic prescriptions and the clinician group providing treatment. The review found that a clinical score was documented for only 38 patients and that 44% of antibiotics were prescribed inappropriately. It is concluded that clinical scores are not being used appropriately in the emergency department to guide antibiotic prescribing for tonsillitis, leading to a high number of inappropriate prescriptions.

Acute sore throat (AST) is a common condition, with 31% of all adults reporting it in 2014; of these, 38% visited a GP for treatment (Kenealy, 2014). The majority of ASTs have an unknown or viral aetiology, with Group A beta-haemolytic Streptococcus (GABHS) identified in only 5–15% of all cases (Cooper et al, 2001). This percentage is lower in children, in whom 1% have GABHS-positive swabs (Hsieh et al, 2011). AST with a viral or bacterial cause is predominantly a self-limiting condition that resolves with simple symptom relief alone (Donowitz, 2021); approximately 40% of cases spontaneously resolve within 3 days of onset.

Historically, untreated GABHS was linked to high rates of acute rheumatic fever (Centers for Disease Control and Prevention, 2018). Early and aggressive antibiotic treatment for AST has been found to reduce rates of the disease and has become a key reason for antibiotic prescribing; however, Petersen et al (2007) found that antibiotics were prescribed unnecessarily to 64% of primary care patients whose AST was not found to be caused by GABHS. This raises concerns around prescribing stewardship, the risks associated with inappropriate antimicrobials and the harm that can be caused by unnecessary treatments. A Cochrane review (Spinks et al, 2013) found that antibiotics provided only modest resolution of symptoms, shortening symptom duration by 16 hours compared to symptom relief alone.

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