Intervention Review

Antibiotics for sore throat

  1. Anneliese Spinks2,
  2. Paul P Glasziou3,
  3. Chris B Del Mar1,*

Editorial Group: Cochrane Acute Respiratory Infections Group

Published Online: 17 MAR 2010

Assessed as up-to-date: 17 MAY 2011

DOI: 10.1002/14651858.CD000023.pub3

Database Title

Additional Information

How to Cite

Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD000023. DOI: 10.1002/14651858.CD000023.pub3.

Author Information

  1. 1

    Bond University, Faculty of Health Sciences and Medicine, Gold Coast, Queensland, Australia

  2. 2

    Griffith University, School of Medicine, Meadowbrook, Queensland, Australia

  3. 3

    Bond University, Centre for Research in Evidence Based Practice, Gold Coast, Queensland, Australia

*Chris B Del Mar, Faculty of Health Sciences and Medicine, Bond University, University Drive, Robina, Gold Coast, Queensland, 4229, Australia. cdelmar@bond.edu.au.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 17 MAR 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Sore throat is a common reason for people to present for medical care. Although it remits spontaneously, primary care doctors commonly prescribe antibiotics for it.

Objectives

To assess the benefits of antibiotics for sore throat for patients in primary care settings.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2011, Issue 2, which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (January 1966 to May week 1, 2011) and EMBASE (January 1990 to May 2011).

Selection criteria

Randomised controlled trials (RCTs) or quasi-RCTs of antibiotics versus control assessing typical sore throat symptoms or complications.

Data collection and analysis

Two review authors independently screened studies for inclusion and extracted data. We resolved differences in opinion by discussion. We contacted trial authors from three studies for additional information.

Main results

We included 27 trials with 12,835 cases of sore throat.

1. Non-suppurative complications
The trend was antibiotics protecting against acute glomerulonephritis but there were too few cases to be sure. Several studies found antibiotics reduced acute rheumatic fever by more than two-thirds within one month (risk ratio (RR) 0.22; 95% confidence interval (CI) 0.02 to 2.08).

2. Suppurative complications
Antibiotics reduced the incidence of acute otitis media within 14 days (RR 0.30; 95% CI 0.15 to 0.58); acute sinusitis within 14 days (RR 0.48; 95% CI 0.08 to 2.76); and quinsy within two months (RR 0.15; 95% CI 0.05 to 0.47) compared to those taking placebo.

3. Symptoms
Throat soreness and fever were reduced by using antibiotics by about half. The greatest difference was seen at day three. The number needed to treat to benefit (NNTB) to prevent one sore throat at day three was less than six; at week one it was 21.

4. Subgroup analyses of symptom reduction
Antibiotics were more effective against symptoms at day three (RR 0.58; 95% CI 0.48 to 0.71) if throat swabs were positive for Streptococcus, compared to RR 0.78; 95% CI 0.63 to 0.97 if negative. Similarly at week one, RR 0.29; 95% CI 0.12 to 0.70 for positive, and 0.73; 95% CI 0.50 to 1.07 for negative Streptococcus swabs.

Authors' conclusions

Antibiotics confer relative benefits in the treatment of sore throat. However, the absolute benefits are modest. Protecting sore throat sufferers against suppurative and non-suppurative complications in high-income countries requires treating many with antibiotics for one to benefit. This NNTB may be lower in low-income countries. Antibiotics shorten the duration of symptoms by about 16 hours overall.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Antibiotics for people with sore throats

Sore throats are infections caused by bacteria or viruses. People usually recover quickly (usually after three or four days), although some develop complications. A serious but rare complication is rheumatic fever, which affects the heart and joints. Antibiotics reduce bacterial infections but they can cause diarrhoea, rash and other adverse effects and communities build resistance to them.

This review of 27 trials with 12,835 cases of sore throat found that antibiotics shorten the illness by an average of about one day and can reduce the chance of rheumatic fever by more than two-thirds in communities where this complication is common.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

喉嚨痛的抗生素治療

民眾常因為喉嚨痛去看醫生。雖然喉嚨痛會自然緩解，基層醫療醫師仍常開立抗生素給病人。

目標

評估抗生素對於喉嚨痛的益處。

搜尋策略

我們搜尋了Cochrane Central Register of Controlled Trials (CENTRAL)及Database of Abstracts of Reviews of Effects (DARE) (2006年， The Cochrane Library，第1期)，MEDLINE(1996年1月至2006年3月)和EMBASE(1990年1月至2005年12月)。

選擇標準

使用抗生素治療喉嚨痛的對照試驗。有些試驗是測量典型症狀(喉嚨疼痛、頭痛或發燒)，有些試驗則是比較化膿性或非化膿性喉嚨病的併發症。

資料收集與分析

相關試驗由兩位作者各自篩檢是否納入分析，若意見不同則經由討論來決定收納與否。納入的研究資料會被獨立抽取出來分析。我們聯繫了三個試驗的研究者以獲得更多的資訊。

主要結論

有27篇試驗被收納，包含2835個喉嚨痛的病例。1.非化膿性的併發症：抗生素治療有預防急性腎絲球腎炎發生的趨勢，但因病例數不足夠無法確定。數個試驗發現抗生素治療能減少超過2/3的急性風濕熱(相對危險(RR) 0.22；95% CI 0.02 to 2.08)。2.化膿性的併發症：抗生素治療(對照安慰劑)可減少急性中耳炎的發生率(RR 0.30; 95% CI 0.15 to 0.58)、急性鼻竇炎的發生率(RR 0.48; 95% CI 0.08 to 2.76)、扁桃腺炎(扁桃腺周圍膿瘍)的發生率(RR 0.15; 95% CI 0.05 to 0.47)。3.症狀： 抗生素治療能減少一半喉嚨疼痛及發燒，最明顯的差異在治療後第3至4天(此時約50%對照組病患症狀已穩定)。1週後約90%治療組和對照組患都已無症狀。為了在發病後第3天減少一個喉嚨痛的患者，整體number need to treat(NNT)剛好小於6(95% CI 4.9 to 7.0)；在發病1週後NNT為21(95% CI 13.2 to 47.9)。 4.症狀緩解的研究子群分析：不論用年齡、雙盲及非雙盲或退燒藥使用等研究子群來分析，使用抗生素對症狀緩解上，都沒有統計上差異。喉頭拭棒結果的研究子群分析則顯示，抗生素使用在第3天時，對症狀預防較為有效。如果喉頭拭棒為鏈球菌陽性，其RR 為0.58(95% CI 0.48 to 0.71)，相對於陰性其RR為0.78 (95% CI 0.63 to 0.97)。在1週時的結果也是類似的，若呈陽性其RRs 0.29 (95% CI 0.12 to 0.70)，陰性則為0.73 (95% CI 0.50 to 1.07)。

作者結論

抗生素在治療喉嚨痛上有相對益處，但絕對益處卻不太大。在西方社會，使用抗生素治療僅能使部分喉嚨痛患者預防化膿性或非化膿性的併發症，但大多數人卻無法從中獲利。在新興經濟體(舉例來說，其急性風濕熱的比率高)，抗生素治療可能是比較有效的(因為NNT可能低得多)。整體來說，抗生素縮減了約16小時的症狀持續時間。

翻譯人

本摘要由慈濟醫院朱培元翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對於多數喉嚨痛的人，抗生素使用效果是有限的。喉嚨痛是細菌或病毒感染引起的，大多數影響小孩或青少年。人們通常在3 – 4天後迅速恢復，雖然某些人會進展出併發症。嚴重但少見的一項併發症就是會影響心臟及關節的急性風濕熱。抗生素可減少細菌感染，但可能引起腹瀉、皮疹和其他有害的副作用，並造成社區抗藥性。這篇系統性回顧發現抗生素能縮短平均約1天的病程。在較常發生風濕熱的社區，抗生素使用也能減少發生機率。

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