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Meta-Analysis
. 2013 Nov 5;2013(11):CD000023.
doi: 10.1002/14651858.CD000023.pub4.

Antibiotics for sore throat

Anneliese Spinks  1 , Paul P Glasziou, Chris B Del Mar
Affiliations
Meta-Analysis

Antibiotics for sore throat

Anneliese Spinks et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Sore throat is a common reason for people to present for medical care. Although it remits spontaneously, primary care doctors commonly prescribe antibiotics for it.

Objectives: To assess the benefits of antibiotics for sore throat for patients in primary care settings.

Search methods: We searched CENTRAL 2013, Issue 6, MEDLINE (January 1966 to July week 1, 2013) and EMBASE (January 1990 to July 2013).

Selection criteria: Randomised controlled trials (RCTs) or quasi-RCTs of antibiotics versus control assessing typical sore throat symptoms or complications.

Data collection and analysis: Two review authors independently screened studies for inclusion and extracted data. We resolved differences in opinion by discussion. We contacted trial authors from three studies for additional information.

Main results: We included 27 trials with 12,835 cases of sore throat. We did not identify any new trials in this 2013 update. 1. Symptoms Throat soreness and fever were reduced by about half by using antibiotics. The greatest difference was seen at day three. The number needed to treat to benefit (NNTB) to prevent one sore throat at day three was less than six; at week one it was 21. 2. Non-suppurative complications The trend was antibiotics protecting against acute glomerulonephritis but there were too few cases to be sure. Several studies found antibiotics reduced acute rheumatic fever by more than two-thirds within one month (risk ratio (RR) 0.27; 95% confidence interval (CI) 0.12 to 0.60). 3. Suppurative complications Antibiotics reduced the incidence of acute otitis media within 14 days (RR 0.30; 95% CI 0.15 to 0.58); acute sinusitis within 14 days (RR 0.48; 95% CI 0.08 to 2.76); and quinsy within two months (RR 0.15; 95% CI 0.05 to 0.47) compared to those taking placebo. 4. Subgroup analyses of symptom reduction Antibiotics were more effective against symptoms at day three (RR 0.58; 95% CI 0.48 to 0.71) if throat swabs were positive for Streptococcus, compared to RR 0.78; 95% CI 0.63 to 0.97 if negative. Similarly at week one the RR was 0.29 (95% CI 0.12 to 0.70) for positive and 0.73 (95% CI 0.50 to 1.07) for negative Streptococcus swabs.

Authors' conclusions: Antibiotics confer relative benefits in the treatment of sore throat. However, the absolute benefits are modest. Protecting sore throat sufferers against suppurative and non-suppurative complications in high-income countries requires treating many with antibiotics for one to benefit. This NNTB may be lower in low-income countries. Antibiotics shorten the duration of symptoms by about 16 hours overall.

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Conflict of interest statement

Paul Glasziou is on the board of Therapeutic Guidelines Limited and holds a research grant from the NHMRC on antibiotic resistance.

Chris Del Mar has received funding from the NHMRC for antibiotic resistance, funding the ARI Cochrane Group, and from some consultancies (GSK for advice about vaccines for otitis media; and a local pharmaceutical company contemplating analgesic ear drops for otitis media).

Anneliese Spinks does not have any interests to declare relevant to this review.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
3
3
Summary of findings.
1.1
1.1. Analysis
Comparison 1 Antibiotics versus placebo for the treatment of sore throats: symptom of sore throat, Outcome 1 Symptom of sore throat on day 3.
1.2
1.2. Analysis
Comparison 1 Antibiotics versus placebo for the treatment of sore throats: symptom of sore throat, Outcome 2 Symptom of sore throat on day 3: blind versus unblinded studies.
1.3
1.3. Analysis
Comparison 1 Antibiotics versus placebo for the treatment of sore throats: symptom of sore throat, Outcome 3 Symptom of sore throat on day 3: antipyretics versus no antipyretics.
1.4
1.4. Analysis
Comparison 1 Antibiotics versus placebo for the treatment of sore throats: symptom of sore throat, Outcome 4 Symptom of sore throat on day 3: GABHS‐positive throat swab, negative swab, untested/inseparable.
1.5
1.5. Analysis
Comparison 1 Antibiotics versus placebo for the treatment of sore throats: symptom of sore throat, Outcome 5 Symptom of sore throat at one week (6 to 8 days).
1.6
1.6. Analysis
Comparison 1 Antibiotics versus placebo for the treatment of sore throats: symptom of sore throat, Outcome 6 Symptom of sore throat at one week (6 to 8 days): blind versus unblinded studies.
1.7
1.7. Analysis
Comparison 1 Antibiotics versus placebo for the treatment of sore throats: symptom of sore throat, Outcome 7 Symptom of sore throat at one week (6 to 8 days): GABHS‐positive throat swab, GABHS‐negative swab.
2.1
2.1. Analysis
Comparison 2 Antibiotics versus control for the treatment of sore throat: symptom of fever, Outcome 1 Symptom of fever on day 3.
2.2
2.2. Analysis
Comparison 2 Antibiotics versus control for the treatment of sore throat: symptom of fever, Outcome 2 Symptom of fever on day 3: blinded versus unblinded studies.
2.3
2.3. Analysis
Comparison 2 Antibiotics versus control for the treatment of sore throat: symptom of fever, Outcome 3 Symptom of fever on day 3: children compared with adults.
2.4
2.4. Analysis
Comparison 2 Antibiotics versus control for the treatment of sore throat: symptom of fever, Outcome 4 Symptom of fever at 1 week (6 to 8 days).
3.1
3.1. Analysis
Comparison 3 Antibiotics versus control for the treatment of sore throat: symptom of headache, Outcome 1 Symptom of headache on day 3.
3.2
3.2. Analysis
Comparison 3 Antibiotics versus control for the treatment of sore throat: symptom of headache, Outcome 2 Symptom of headache on day 3: blinded versus unblinded studies.
4.1
4.1. Analysis
Comparison 4 Antibiotics versus placebo for the treatment of sore throat: incidence of complications, Outcome 1 Incidence of acute rheumatic fever within 2 months. Rheumatic fever defined by clinical diagnosis.
4.2
4.2. Analysis
Comparison 4 Antibiotics versus placebo for the treatment of sore throat: incidence of complications, Outcome 2 Incidence of acute rheumatic fever within 2 months. Penicillin versus placebo.
4.3
4.3. Analysis
Comparison 4 Antibiotics versus placebo for the treatment of sore throat: incidence of complications, Outcome 3 Incidence of acute rheumatic fever within 2 months: early (pre‐1975) versus late studies (post‐1975).
4.4
4.4. Analysis
Comparison 4 Antibiotics versus placebo for the treatment of sore throat: incidence of complications, Outcome 4 Incidence of otitis media within 14 days. Otitis media defined by clinical diagnosis.
4.5
4.5. Analysis
Comparison 4 Antibiotics versus placebo for the treatment of sore throat: incidence of complications, Outcome 5 Incidence of otitis media within 14 days: early (pre‐1975) versus late studies (post‐1975).
4.6
4.6. Analysis
Comparison 4 Antibiotics versus placebo for the treatment of sore throat: incidence of complications, Outcome 6 Incidence of sinusitis within 14 days. Sinusitis defined by clinical diagnosis.
4.7
4.7. Analysis
Comparison 4 Antibiotics versus placebo for the treatment of sore throat: incidence of complications, Outcome 7 Incidence of quinsy within 2 months. Quinsy defined by clinical diagnosis.
4.8
4.8. Analysis
Comparison 4 Antibiotics versus placebo for the treatment of sore throat: incidence of complications, Outcome 8 Incidence of acute glomerulonephritis within 1 month. Acute glomerulonephritis defined by clinical diagnosis.
See this image and copyright information in PMC

Update of

Comment in

  • Antibiotics for sore throat.
    Kocher JJ, Selby TD. Kocher JJ, et al. Am Fam Physician. 2014 Jul 1;90(1):23-4. Am Fam Physician. 2014. PMID: 25077497 No abstract available.

References

References to studies included in this review

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References to other published versions of this review

Del Mar 1997
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