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Sore throat and sinusitis, and the few benefits of antibiotics

An analysis of the evidence in the latest issue of Australian Prescriber suggests antibiotics have very few benefits for treating sore throat and acute sinusitis. Both conditions are common reasons for visits to the doctor.

Chris Del Mar, Professor of Public Health at Bond University, writes that because of the spectre of antibiotic resistance—something that is approaching a catastrophe—questions need to be asked about treatment of these conditions.

“The evidence shows that, in the case of antibiotics for sore throat and acute sinusitis, the benefits are marginal and antibiotic harms need to be factored in.”

Professor Del Mar says that as both sore throat and sinusitis get better on their own, three key questions should be asked:

  • Do antibiotics reduce the severity or duration of symptoms?
  • Do they reduce complications?
  • Do other interventions relieve symptoms?

“Evidence is accumulating that antibiotics deliver common harms, including rashes, diarrhoea and thrush. With antibiotic use, as well as the harms at the population level, individuals may carry antibiotic-resistant bacteria for up to 12 months following a course of antibiotics.”

Professor Del Mar says that it’s time to move on from many long-held beliefs on antibiotic use. “It’s hard to appreciate that 100 years ago parents were afraid of ‘strep throat’, an infectious disease that could kill. Historically, sore throat was of greater concern for its complications, such as acute rheumatic fever, rather than its symptoms. Outside of indigenous populations, the risk of rheumatic fever is now low (one case in every 10 GP-practising lifetimes), and is a weak justification for antibiotic use.”

“A difficulty facing prescribers is that treatment options for sore throat and acute sinusitis are few. However, the illnesses regularly resolve without treatment and complications are rarely a problem.” Professor Del Mar suggests how to address the challenge of communicating these complexities to patients and their parents.

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