Antibiotics are still being overprescribed to children with sore throats, and kids who do need them are often given the wrong ones, a new study shows.

It is estimated that at most about a third of children who are treated by physicians for sore throats actually have strep throat, with some studies suggesting that as few as 15 percent have the bacterial infection.

Although many people might refer to any sore throat as “strep throat," a true strep throat is one caused by infection from streptococci bacteria.

Antibiotics were prescribed to more than half of the children in the new study, published in the Nov. 9 issue of The Journal of the American Medical Association.

And roughly one in four prescriptions involved antibiotics other than those recommended, potentially increasing the risk for treatment failure and future drug resistance.

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Not All Bad News

The findings are somewhat discouraging in light of aggressive efforts to educate physicians and the public about the dangers of antibiotic overuse, the study’s researcher tells WebMD.

But he added that there is also reason for optimism. The total number of antibiotic prescriptions written for children with sore throats fell from 66 percent in 1995 to 53 percent in 2003.

“The overall trend is down, but clearly there are still too many antibiotics being prescribed,” says Jeffrey A. Linder, MD, MPH, of Brigham and Women’s Hospital and Harvard Medical School.

Linder and colleagues analyzed data from two national medical care surveys that included information on roughly 7,000 pediatric visits to physicians for sore throats.

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Kids and Strep Tests

The researchers found that a test that confirms strep throat was given only about half the time and seemed to have no impact on whether physicians prescribed antibiotics or not.

“All kids should be given a strep test before they are treated with antibiotics,” Linder says.

But that doesn’t mean that every child who sees the doctor for a sore throat needs a strep test, he adds. If other symptoms indicate a cold or other viral infection no test may be needed.

Linder notes that symptoms not suggestive of strep throat include:

--Sniffles or runny nose


--Hoarse voice

--Pink eye


--Symptoms, other than sore throat, that suggest strep throat include:

--High fever Sudden onset of symptoms

--Abdominal pain

--Nausea and vomiting


--Tender lymph nodes in the neck

“It isn’t always clear with kids, though, and that is why testing is so important if there is any question,” he says.

Antibiotics Do Nothing for Most Sore Throats

The Wrong Drugs

The world’s first antibiotic remains the drug of choice for the treatment of children with strep throat. Leading pediatric and infectious disease groups, including the CDC, recommend penicillin whenever possible. Acceptable alternatives include three other long-relied on antibiotics -- amoxicillin, erythromycin, and first-generation cephalosporins.

But newer, nonrecommended antibiotics were prescribed to 27 percent of the patients who received an antibiotic. Linder speculates that the physicians and/or parents mistakenly believed that "newer" meant better.

“The irony is that the bug that causes strep throat is sometimes resistant to these newer antibiotics, but it is never resistant to penicillin,” he says. “Penicillin is well tolerated, inexpensive, and it has a narrow spectrum of activity, meaning that it targets the bug that causes strep throat and little else.”

The bottom line, Linder says, is that most kids with sore throats probably shouldn’t be taking antibiotics, and a strep test should always be given before antibiotics are prescribed.

J. Todd Weber, MD, who directs the Office of Antimicrobial Resistance at the CDC, agrees.

Weber tells WebMD that he believes doctors and the lay public have gotten the message about the dangers of antibiotic overuse for society. But that may not be translating to the care of the individual patient.

He says doctors need better tools to help them determine which patients will and will not benefit from antibiotics. And they need to make better use of the tools they have, like the strep test.

“If we are going to get serious about preserving the effectiveness of [antibiotics] we have to employ the tests we have -- and we don’t have many -- that can reliably determine if the drugs are needed.”

By Salynn Boyles, reviewed by Louise Chang, MD

SOURCES: Linder, J.A. and Samore, M.H. The Journal of the American Medical Association, Nov. 9, 2005; vol 294: pp 2305-2322. Jeffrey A. Linder, MD, MPH, instructor in medicine, Harvard Medical School; associate physician, Brigham and Women’s Hospital, Boston. J. Todd Weber, MD, director, Office of Antimicrobial Resistance, National Center for Infectious Diseases, CDC, Atlanta.