Antibiotics for sore throats overprescribed: Study

Matt Woodley

13/08/2019 11:48:58 AM

Busy GPs could benefit from more support when attempting to reduce the use of antibiotics.

Examining throat
The Modified Centor Criteria can be used to indicate the likelihood of Strep A in children and adults.

New research, published in the Australian Journal of General Practice, has found some doctors frequently prescribe antibiotics for ‘strep throat’ without using an extended consultation that may indicate a viral infection rather than a bacterial one.
Fewer than half of all consultation notes collected from 2015–16 as part of the study showed the implementation of a set of criteria used to identify the likelihood of a bacterial infection in patients presenting with a sore throat, which in turn impacted prescribing rates.
Flinders University researcher and lead author Dr Chirag Patel told newsGP there could be a number of reasons some doctors had not utilised the Modified Centor Criteria (MCC) during consultations.
‘It’s probably a combination of things. One, some GPs obviously see a lot more patients than others – they’re really inundated and time-pressured,’ he said.
‘The second aspect is that you have patients pushing for antibiotics. They have an agenda straight away when they come into the consult: “Actually, I’m here for only one thing and that’s antibiotics”. That also adds to original point, as it takes time to explain all of those things [about antimicrobial resistance].
‘The third aspect is potentially education. In the study, there were GPs that were from overseas [for example] that may not be fully aware of all the guidelines.’
Dr Patel believes GPs need more support in attempts to reduce the use of antibiotics.
‘We found if all components were recorded in the patient notes then they would be less likely to get antibiotics,’ Dr Patel said.
‘[But] if I went through all my consults where I’ve had to explain about antibiotics, I think that would take up quite a lot of my time, so in terms of remuneration GPs are perhaps not supported enough.’
Should a patient be adamant about receiving antibiotics, Dr Patel believes the best way to convince them otherwise is to explain the risks and lack of benefit succinctly and clearly.
‘I go into quite a lot of detail to explain why antibiotics aren’t needed, and I even mention the score that we reference in the study – I go through that individually and what that means for them,’ he said.
‘I’ve also got a lot of posters up in my consulting room that talk about antibiotic prescribing and why it’s not necessary. So when I’m entering information on my computer, the patients are looking at my posters, and already taking information in before I’ve even spoken to them [about it].’
The MCC is a simple score that takes into account the age of the patient, the presence of swollen tonsils with or without pus, tender/swollen anterior cervical lymph nodes, a fever of above 38°C, and whether a cough is present.
Even if all the criteria are present, the probability of symptoms being the result of a strep A infection is only 53%.
Yet, according to the study, which analysed 1761 consultations in two rural clinics in South Australia, more than 80% of patients were prescribed antibiotics for tonsillitis, pharyngitis or tonsillopharyngitis.
As a result, Dr Patel believes antibiotics are sometimes overprescribed – particularly given Australia is considered a ‘low risk’ country regarding complications related to sore throat.

AJGP antimicrobial resistance Modified Centor Criteria prescribing strep throat

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Dr Nicholas Francis Carr   14/08/2019 5:39:27 PM

Dr Patel is, I believe, being a bit too kind to doctors:

- applying the MCC takes very little time (ask about coryzal symptoms, check temp and glands, look in throat - one minute?)
- few patients 'demand' antibiotics, They might have been taught to expect them (by their doctor...), but research shows that most patients who expect ABs are happy not to receive them if given a simple, brief explanation of why they're not needed.

Some doctors may be poorly educated, but I fear the real answer is that too many doctors have a long history of over-prescribing ABs, and their patients now expect them. It's easier to blame the 'demanding patients' rather than accept the uncomfortable truth, which is that poor practice is the real underlying cause.

Michael Fasher   16/08/2019 10:23:45 PM

Dr Patel is far too kind
In the practice I founded 40 years ago it would be astonishing if a parent or patient came seeking an antibiotic solution to rotten viral misery
Empathy first second and third
Then build confidence & competence
I love it!!!! Go GP1

Dr Kate Frances Douglas   17/08/2019 4:51:18 PM

Can you advise where to obtain posters about antibiotic prescribing? Thanks!