Is amoxicillin (amox) 500mg twice daily (BID) for 7 days appropriate for a 61-year-old male with a sore throat and low-grade fever for 5 days, with negative streptococcal (strep) test and throat culture results?

From the Guidelines

Amoxicillin 500mg twice daily for 7 days is not appropriate for this 61-year-old male with sore throat and low-grade fever, especially given the negative strep test and throat culture. This presentation most likely represents a viral pharyngitis, which does not respond to antibiotics. Antibiotics like amoxicillin should be reserved for bacterial infections, particularly group A streptococcal pharyngitis, which has been ruled out in this case 1. Unnecessary antibiotic use can lead to side effects such as diarrhea, rash, and potential allergic reactions, while also contributing to antibiotic resistance. Instead, symptomatic treatment is recommended, including over-the-counter pain relievers like acetaminophen or ibuprofen, warm salt water gargles, and adequate hydration 1. If symptoms worsen or persist beyond 7-10 days, the patient should follow up for reassessment as this could indicate a complication or different diagnosis requiring alternative management. Key points to consider in the management of this patient include:

• The low likelihood of group A streptococcal pharyngitis in adults, especially with negative diagnostic tests 1
• The importance of avoiding unnecessary antibiotic use to prevent resistance and side effects 1
• The role of symptomatic treatment in managing viral pharyngitis 1

From the FDA Drug Label

Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic, or evidence of bacterial eradication has been obtained It is recommended that there be at least 10 days’ treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever. Ear/Nose/Throat Mild/ Moderate 500 mg every 12 hours or 250 mg every 8 hours

The patient has a sore throat and low-grade fever for 5 days with negative streptococcal test and throat culture results. Amoxicillin 500mg BID x 7days is not appropriate for this patient as the treatment duration is less than the recommended 10 days for Streptococcus pyogenes infections, and the patient's test results do not confirm a bacterial infection that would require amoxicillin treatment 2.

From the Research

Sore Throat Treatment

• The patient is a 61-year-old male with a sore throat and low-grade fever for 5 days, with negative streptococcal (strep) test and throat culture results.
• The use of amoxicillin (amox) 500mg twice daily (BID) for 7 days may not be appropriate in this case, as the patient has a negative strep test and throat culture results, suggesting a viral or non-bacterial cause of the sore throat 3.
• According to the clinical practice guideline for sore throat, antibiotics are not indicated if the risk of bacterial pharyngitis is low, and the patient's symptoms can be managed with non-pharmacological self-management and symptomatic treatment with ibuprofen or naproxen 4.

Antibiotic Use

• The use of antibiotics for sore throat is a controversial topic, and there is no clearly superior management strategy for strep throat 5.
• A systematic review of antibiotics for treatment of sore throat in children and adults found that antibiotics reduced the symptoms of sore throat, but the effect was small, and the balance between modest symptom reduction and the potential hazards of antimicrobial resistance must be recognized 6.
• The review also found that antibiotics reduced the incidence of acute otitis media and quinsy, but not acute sinusitis, and probably reduced the number of people experiencing sore throat and headache 6.

Treatment Recommendations

• The patient's treatment should be based on the clinical practice guideline for sore throat, which recommends non-pharmacological self-management and symptomatic treatment with ibuprofen or naproxen for acute sore throat 4.
• If the patient's symptoms persist or worsen, further evaluation and treatment may be necessary, but the use of antibiotics should be based on a careful assessment of the patient's risk of bacterial pharyngitis and the potential benefits and harms of antibiotic treatment 5, 6, 4.