When does your child’s sore throat need an antibiotic? It’s an important question, and it appears, many doctors don’t really know the answer. Sore throats account for six percent of all visits by kids to family practice doctors and pediatricians. So, this is one of the most important reasons to see the doctor. And with the looming worries over antibiotic resistance, over-prescribing these medicines for this problem is a major cause of concern among infectious disease experts. “Unless she really, really has to take them and there is no other way of her getter better, than I’ll have her take it, otherwise I prefer for if it is a viral infection for it to run its course basically,” says nine year old Nicole’s mom.
When does your child’s sore throat need an antibiotic? It’s an important question, and it appears, many doctors don’t really know the answer. Sore throats account for six percent of all visits by kids to family practice doctors and pediatricians. So, this is one of the most important reasons to see the doctor. And with the looming worries over antibiotic resistance, over-prescribing these medicines for this problem is a major cause of concern among infectious disease experts.
"Unless she really, really has to take them and there is no other way of her getter better, than I’ll have her take it, otherwise I prefer for if it is a viral infection for it to run its course basically," says nine year old Nicole’s mom. It’s a smart perspective that many parents don’t have when their child has a sore throat. Dr. Stephen Turner, a pediatrician at Long Island College Hospital, New York, says, "There are still parents who want their child to get antibiotics, they feel that they will get better sooner if they have antibiotics."
And really, that’s what infectious disease specialists want parents and doctors to have: only use antibiotics when the sore throat calls for one. But new research in the Journal of the American Medical Association shows still, doctors are prescribing these bacteria-fighters far too often. The study found doctors prescribed antibiotics in 53 percent of all visits for a sore throat. The reality—only 15 to at most 36 percent of sore throats are caused by a bacteria—namely, strep-- that calls for an antibiotic. The rest of sore throats are caused by viruses.
"In general if you have a viral pharyngitis or mono it won’t do you any good for one thing because antibiotics don’t treat viral infections," says Dr. Turner. To reduce unnecessary antibiotic treatment, it is recommended that a rapid strep test be performed prior to treating children with an antibiotic. Still, only about half of the patients getting an antibiotic first had a rapid strep test. "The test is very, pretty sensitive and specific so that if you have strep throat over 90 percent of the time you are going to test positive on the rapid strep test. If you don’t have strep throat it is very, very unlikely that it would test positive," Dr. Turner states.
Of concern: the antibiotics being prescribed are still the wrong ones: ones like Augmentin, and Zithromax, or Z-pac, which should be reserved for more serious infections. By overusing antibiotics in general and the more powerful ones in particular, we are putting ourselves at risk for the medicines not working in the future, because the bacteria get to know them and adapt to them. "So if an antibiotic is used over and over and over again through out the population eventually it won’t kill the bacteria that we need it to kill," Dr. Turner states.
Again, every patient who is being considered for an antibiotic or gets an antibiotic should get a rapid strep test or a throat culture. If a child has a high fever, a headache, serious pain on swallowing, a headache…it might be strep, and the child should be tested. If though, there’s a cough, or hoarseness, those are indications of a viral illness instead.
The bottom line: a culture or rapid strep test will give the answer. And if the child is initially treated with antibiotics and the tests turn out negative, the antibiotic should be stopped. The drug of choice: Penicillin—not Zithromax or Biaxin. Experts say they’re seeing an increase in resistance to these medicines because of overuse.