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Linder JA, Stafford RS. Antibiotic Treatment of Adults With Sore Throat by Community Primary Care Physicians: A National Survey, 1989-1999. JAMA. 2001;286(10):1181–1186. doi:10.1001/jama.286.10.1181
Author Affiliations: General Medicine Division, Massachusetts General Hospital, Boston (Dr Linder); and Stanford Center for Research in Disease Prevention, Palo Alto, Calif (Dr Stafford).
Context Most sore throats are due to viral upper respiratory tract infections.
Group A β-hemolytic streptococci (GABHS), the only common cause of sore
throat warranting antibiotics, is cultured in 5% to 17% of adults with sore
throat. The frequency of antibiotic use for pharyngitis has greatly exceeded
the prevalence of GABHS, but less is known about specific classes of antibiotics
used. Only penicillin and erythromycin are recommended as first-line antibiotics
Objectives To measure trends in antibiotic use for adults with sore throat and
to determine predictors of antibiotic use and nonrecommended antibiotic use.
Design, Setting, and Subjects Retrospective analysis of 2244 visits to primary care physicians in
office-based practices in the National Ambulatory Medical Care Survey, 1989-1999,
by adults with a chief complaint of sore throat.
Main Outcome Measures Treatment with antibiotics and treatment with nonrecommended antibiotics,
extrapolated to US annual national rates.
Results There were an estimated 6.7 million annual visits in the United States
by adults with sore throat between 1989 and 1999. Antibiotics were used in
73% (95% confidence interval [CI], 70%-76%) of visits. Patients treated with
antibiotics were given nonrecommended antibiotics in 68% (95% CI, 64%-72%)
of visits. From 1989 to 1999, there was a significant decrease in use of penicillin
and erythromycin and an increase in use of nonrecommended antibiotics, especially
extended-spectrum macrolides and extended-spectrum fluoroquinolones (P<.001 for all trends). In multivariable modeling, increasing
patient age (odds ratio [OR], 0.86 per decade; 95% CI, 0.79-0.94) and general
practice specialty (OR, 1.54 compared with family practice specialty; 95%
CI, 1.10-2.14) were independent predictors of antibiotic use. Among patients
receiving antibiotics, nonrecommended antibiotic use became more frequent
over time (OR, 1.17 per year; 95% CI, 1.11-1.24).
Conclusions More than half of adults are treated with antibiotics for sore throat
by community primary care physicians. Use of nonrecommended, more expensive,
broader-spectrum antibiotics is frequent.
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