Recommendations

Decision aid: antibiotics for sore throat

​It is estimated that Group A Strep is responsible for 15-30% of cases of acute tonsillitis.
 
Over the past few years we have seen a practice shift, moving away from prescribing antibiotics for all children presenting with acute tonsillitis, instead targeting therapy at those in high risk groups.

​This is based on a number of studies and Cochrane reviews, which concluded:

• Group A Strep is a self-limiting illness and even without antibiotics, 90% of patients will be symptom free at 1week, with most illnesses lasting 3-4days 
• Antibiotic therapy is shown to shorten the illness by just 16hrs
• To prevent one case of secondary acute otitis media we would need to treat 200 children with antibiotics
• Antibiotic therapy reduces the risk of acute rheumatic fever by 2/3. The incidence of acute rheumatic fever in the general population in Australia is very low at <1 per 100,000. In Indigenous populations it is 69 times that and so this is the group that will benefit most from antibiotic treatment.

 
Current indications for antibiotics:

• 2-25yr old Indigenous Australians, Maori, Pacific Islanders  
• Personal or family hx of rheumatic heart disease
• Personal or family hx of rheumatic fever

 
It can be difficult to explain to families why we are not prescribing antibiotics. This decision aid from the Australian Commission on Safety and Quality in Healthcare is a great tool that demonstrates the evidence in graphic form. This can be printed and used as part of a shared decision-making discussion with families. 

Dr Danielle Scarfe