From the Guidelines
Antibiotics should not be prescribed for a sore throat that tests negative for strep and influenza, as the benefits do not outweigh the risks of antibiotic resistance and side effects. The majority of sore throats are caused by viral infections, and antibiotics are ineffective against these 1. According to the American College of Physicians and the Centers for Disease Control and Prevention, antibiotics are only recommended for patients with confirmed streptococcal pharyngitis 1.
For patients with a sore throat, symptomatic treatment is the most appropriate course of action, including:
- Rest
- Adequate hydration
- Over-the-counter pain relievers like acetaminophen or ibuprofen
- Throat lozenges or warm salt water gargles
However, if symptoms are severe or persist beyond 7-10 days, worsen after initial improvement, or if the patient has a compromised immune system, a follow-up evaluation may be warranted to consider other bacterial causes 1. In these specific cases, antibiotics might be considered, but the decision should be based on clinical judgment rather than patient expectation, as unnecessary antibiotic use poses risks including side effects, allergic reactions, and contributing to the growing public health concern of antibiotic resistance 1.
From the FDA Drug Label
To reduce the development of drug-resistant bacteria and maintain the effectiveness of amoxicillin and other antibacterial drugs, amoxicillin should be used only to treat infections that are proven or strongly suspected to be caused by bacteria
- The patient has a sore throat negative for strep and influenza, but the presence of another bacterial infection is possible.
- According to the drug label, amoxicillin should be used only to treat infections that are proven or strongly suspected to be caused by bacteria 2.
- Since the patient's sore throat is negative for strep and influenza, there is no clear evidence of a bacterial infection that would justify the use of amoxicillin.
- Therefore, amoxicillin should not be given to the patient without further evidence of a bacterial infection.
From the Research
Antibiotic Treatment for Sore Throat
- If a sore throat is negative for strep and influenza, the decision to prescribe antibiotics for a possible other bacterial infection should be based on clinical judgment and guidelines 3, 4.
- The use of clinical decision rules, such as assessing the risk of group A beta-hemolytic streptococcal infection, can help determine the need for antibiotics 3.
- Guidelines recommend using rapid antigen testing if a diagnosis is unclear, and a throat culture is recommended in children and adolescents after a negative rapid antigen test result 3.
- Penicillin and amoxicillin are first-line antibiotics for treating group A beta-hemolytic streptococcal pharyngitis, with a recommended course of 10 days 3, 4.
- However, there is significant resistance to azithromycin and clarithromycin in some parts of the United States, and their use should be considered carefully 3.
Considerations for Antibiotic Prescription
- The prescription of antibiotics should be based on a risk-adapted approach, using clinical scores to assess the risk of bacterial pharyngitis 4.
- If the risk is low, antibiotics are not indicated, while a moderate or high risk may warrant delayed or immediate prescribing of antibiotics, respectively 4.
- It is essential to consider the potential for antibiotic resistance and the low risk of complications in many cases of acute sore throat before prescribing antibiotics 4, 5.
Alternative Treatments and Considerations
- Non-pharmacological self-management, ibuprofen, and naproxen are recommended for symptomatic treatment of sore throat 4.
- The use of corticosteroids, non-steroidal anti-inflammatory drugs, and paracetamol may also be considered for symptom relief 6.
- However, the effectiveness and safety of these interventions should be evaluated based on the individual patient's needs and medical history 6.