Antibiotics for sore throat

  • Comment
  • Review
  • Intervention

Authors


Abstract

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 CENTRAL 2013, Issue 6, MEDLINE (January 1966 to July week 1, 2013) and EMBASE (January 1990 to July 2013).

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. We did not identify any new trials in this 2013 update.

1. Symptoms
Throat soreness and fever were reduced by about half by using antibiotics. 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.

2. 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) 0.27; 95% confidence interval (CI) 0.12 to 0.60).

3. 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.

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 the RR was 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

Antibiotics for people with sore throats

Question

This review sought to determine whether antibiotics are effective for treating the symptoms and reducing the potential complications associated with sore throats.

Background

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 diarrhea, rash and other adverse effects and communities build resistance to them.

Study characteristics

The review is current to July 2013 and included 27 trials with 12,835 cases of sore throat. All of the included studies were randomised, placebo-controlled trials which sought to determine if antibiotics helped reduce symptoms of either sore throat, fever and headache or the occurrence of more serious complications. Studies were conducted among both children and adults.

Key results

The review found that antibiotics shorten the duration of pain symptoms 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. Other complications associated with sore throat are also reduced through antibiotic use.

Quality of evidence

The quality of the included studies was moderate to high. However, there were very few recent trials included in the review (only three since 2000), hence it is unclear if changes in bacterial resistance in the community may have affected the effectiveness of antibiotics.

Laički sažetak

Antibiotici za liječenje boli u grlu (grlobolje)

Istraživačko pitanje

Cochrane sustavni pregled istražio je učinkovitost antibiotika u liječenju simptoma grlobolje i potencijalnih komplikacija.

Dosadašnje spoznaje

Grlobolja nastaje zbog upale uzrokovane bakterijama ili virusima. Pacijenti se obično brzo oporavljaju (najčešće unutar tri ili četiri dana), iako neki razviju komplikacije. Ozbiljna, ali rijetka komplikacija upale grla je reumatska groznica, koja pogađa srce i zglobove. Antibiotici djeluju na bakterijske infekcije, ali mogu uzrokovati proljev, osip i druge nuspojave, a isto tako populacija može postati otporna na njih.

Obilježja uključenih istraživanja

Cochrane sustavni pregled iz lipnja 2013. uključio je 27 kliničkih istraživanja s ukupno 12.835 slučajeva grlobolje. Sve uključene studije bile su randomizirana, placebo-kontrolirana istraživanja u kojima je analizirano mogu li antibiotici ublažiti grlobolju, vrućicu i glavobolju, ili pojavu ozbiljnijih komplikacija. Istraživanja su provedena na djeci i odraslima.

Ključni rezultati

Rezultati sustavnog pregleda pokazuju da antibiotici skraćuju trajanje boli za prosječno jedan dan i da mogu smanjiti vjerojatnost od reumatske groznice za trećinu u zajednicama gdje se ova komplikacija često javlja. Druge komplikacije grlobolje također su smanjene korištenjem antibiotika.

Kvaliteta dokaza

Kvaliteta uključenih istraživanja bila je umjerena ili visoka. Međutim, u sustavni pregled je uključeno vrlo malo novijih istraživanja (svega tri koja su objavljena nakon 2000. godine) pa stoga nije jasno kako promjene u otpornosti bakterija na antibiotike, koje se viđaju u zajednici, utječu na učinkovitost antibiotika.

Bilješke prijevoda

Hrvatski Cochrane
Prevela: Livia Puljak
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr

Резюме на простом языке

Антибиотики для людей с болью в горле

Вопрос

Этот обзор проведен, чтобы определить, эффективны ли антибиотики в лечении симптомов и уменьшении возможных осложнений, связанных с болью в горле.

Актуальность

Боль в горле является проявлением инфекции, вызванной бактериями или вирусами (ангина/фарингит). Выздоровление обычно наступает быстро (как правило, через три или четыре дня), но у некоторых людей развиваются осложнения. Серьезным, но редким осложнением является ревматизм (ревматическая лихорадка), который поражает сердце и суставы. Антибиотики подавляют бактериальные инфекции, но они могут вызвать диарею, сыпь и другие неблагоприятные эффекты, а в обществе может выработаться резистентность к ним.

Характеристика исследований

Этот обзор актуален по июль 2013 года, и включил 27 испытаний с 12 835 случаями боли в горле. Все включенные исследования были рандомизированными плацебо-контролируемыми испытаниями, которые имели целью определить, помогают ли антибиотики уменьшить боль в горле, лихорадку и головную боль или развитие более серьезных осложнений. Исследования были проведены у детей и взрослых.

Основные результаты

Этот обзор обнаружил, что антибиотики сокращают продолжительность симптомов боли в среднем на 1 день и могут уменьшить вероятность развития ревматизма более чем на две трети в сообществах, в которых это осложнение является распространенным явлением. Другие осложнения, связанные с болью в горле, также уменьшаются при использовании антибиотиков.

Качество доказательств

Качество включенных исследований варьировало от среднего до высокого. Однако было очень мало недавних испытаний, включенных в обзор (только три с 2000 года), следовательно, неясно, могли ли изменения в бактериальной резистентности в обществе повлиять на эффективность антибиотиков.

Заметки по переводу

Перевод: Гарифова Диния Динаровна. Редактирование: Кораблева Анна Александровна. Координация проекта по переводу на русский язык: Cochrane Russia - Кокрейн Россия (филиал Северного Кокрейновского Центра на базе Казанского федерального университета). По вопросам, связанным с этим переводом, пожалуйста, обращайтесь к нам по адресу: cochrane.russia.kpfu@gmail.com; cochranerussia@kpfu.ru

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