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Source: Linder JA, Stafford RS. JAMA. 2001;286:1181-1186.
Despite the fact that a diversity of suggested management plans for acute upper respiratory infections abounds, clinicians often use methods that reflect practice contrary to such guidance. Linder and Stafford propose that in cases of sore throat, the only bacteria that merits treatment is Group A beta-hemolytic streptococci (GABHS), for which first-line treatment recommendations generally include penicillin and erythromycin.
Linder and Stafford performed a retrospective analysis of 2244 adult primary care visits for sore throat over a 10-year period (1989-1999). Almost three-fourths of patients received antibiotic treatment, though it has been repeatedly demonstrated that the majority of adult pharyngitis cases are viral. Additionally, less than one-third of the antibiotic prescriptions were for penicillin or erythromycin.
Over the 10-year study period, use of nonrecommended antibiotics actually increased. On the other hand, in the most recent year surveyed, overall antibiotic prescribing was reduced by almost one third, though there was no diminution of nonrecommended antibiotic use, most common of which was prescription of aminopenicillins. They have demonstrated that community-based primary care physicians commonly overprescribe antibiotics, and often choose agents that are not traditionally recommended as first-line.