I congratulate Drs Worrall, Hutchinson, Sherman, and Griffiths on their research article in the April 2007 issue of Canadian Family Physician.1 They compared rapid antigen detection tests and clinical examination for differentiating sore throats of viral and bacterial etiology. They concluded that use of rapid antigen detection kits in primary care settings could reduce the prescribing rate of antibiotics for sore throats.
An equally interesting question is, Why do we treat sore throats with antibiotics at all?
As mentioned in the article, symptoms caused by a bacterial sore throat fail to clear much faster when treated with antibiotics than they would if left alone.
Do we treat to prevent rheumatic fever and glomerulonephritis? There is no convincing evidence that, for the Western world, treating streptococcal sore throats with penicillin prevents either of these conditions. Common sense might tell us that if we were to consider the number of patients who do not visit their doctors when they have sore throats and the cases of bacterial sore throats that do not receive antibiotics because we misdiagnose them as viral, there must be thousands of cases of untreated strep throat every year in this country alone. Should we then not be seeing more rheumatic fever and glomerulonephritis?
Do we treat because we feel that patients expect antibiotics? Many of my patients are terrified of strep. Mothers who fail to vaccinate their children because they do not believe in tetanus, polio, diphtheria, and pertussis (“and vaccination is so unnatural, Doctor”) will rush those same children into my office every time they have sore throats. It is certainly easier and quicker to hand out prescriptions every time than to explain and reassure. Each time we do this, however, we reinforce patients’ fears.
Do family physicians have to declare a conflict of interest in answering these questions? If we were to lower ourselves to examining the vulgar subject of money, it is certainly in our financial interest to keep many patients scared enough to rush to our offices whenever they get sore throats.
In view of the large number of antibiotics prescribed for sore throats, perhaps it is time to review whether we should be using such treatment for strep throat infections at all.
- Copyright© the College of Family Physicians of Canada
