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Antibiotic Prescribing to Adults With Sore Throat in the United States, 1997-2010

Michael L. Barnett, MD1,2; Jeffrey A. Linder, MD, MPH1,2
[+] Author Affiliations
1Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
2Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. 2014;174(1):138-140. doi:10.1001/jamainternmed.2013.11673.
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Among adults seeking care with sore throat, the prevalence of group A Streptococcus (GAS) infection—the only common cause of sore throat requiring antibiotics—is about 10%.1 Penicillin remains the antibiotic of choice. Penicillin is narrow-spectrum, well-tolerated, and inexpensive, and GAS is universally susceptible to penicillin.

We previously found that the antibiotic prescribing rate for adults making a visit with sore throat dropped from about 80% to 70% around 1993.2 Since then, the Centers for Disease Control and Prevention and others have continued efforts to reduce inappropriate antibiotic prescribing.35 To measure changes in antibiotic prescribing for adults with sore throat, we conducted a cross-sectional analysis of ambulatory visits in the United States.

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Antibiotic Prescribing to Adults With Sore Throat in the United States, 1997-2010

A, Antibiotic prescribing for all sore throats, primary care practices, and emergency departments (EDs). For linear trends, P = .31 for all sore throat visits; P = .35 for primary care visits; and P = .75 for ED visits. B, Antibiotic prescribing by antibiotic class. Each open circle represents an estimate below the threshold of reliable measurement. Other second-line antibiotics were first-generation cephalosporins, clarithromycin, and clindamycin. The most commonly prescribed nonrecommended antibiotics were cephalosporins (37% of category), penicillin/β-lactamase combinations (27%), and fluoroquinolones (13%). For trends, P = .27 for penicillin; P < .001 for azithromycin; P = .33 for amoxicillin; and P = .37 for nonrecommended antibiotics.

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