12 September 2018

Still too many antibiotic scripts for sore throats

General Practice Paediatrics

GPs are handing out antibiotics prescriptions for children with sore throats at a much higher rate than emergency departments, a study by Macquarie University researchers has found.

In around two-thirds of cases, GPs went against guidelines by prescribing antibiotics to children presenting with a sore throat and no other signs of tonsillitis.

Emergency departments, by contrast, only provided antibiotics to children under 15 who probably didn’t need them 7% of the time.

The rates were higher for children under the age of four who also had a cough, with GPs  and EDs prescribing antibiotics to the majority of patients (87% and 61%, respectively).

The results indicated a concerning over-reliance on antibiotics, which would contribute to the increasing global problem of antibiotic resistance, Peter Hibbert, the lead author on the paper and program manager at Australian Institute of Health Innovation at Macquarie University, said.

GPs might be prescribing antibiotics to meet parental expectations, he said.

Clinicians in an ED setting also might be more likely to be following established institutional systems based on clinical practice guidelines than GPs.

The study was undertaken as one of several in a larger project called the CareTrack Kids program, and involved an analysis of the records of around 800 children.

Current guidelines recommend that caregivers of children with a sore throat be advised on self-care options including to give the child plenty of water, monitoring them and returning for a follow-up if the child deteriorates.

“Our study showed that this advice is often not given in the GP clinic,” Mr Hibbert said.

In the study, around one-third of GPs (and 73% of EDs) instructed parents to provide fluids.

“[GPs] may feel pressured by time constraints during consultations and so don’t seek to inform caregivers of self-care options such as increasing fluid intake,” Mr Hibbert said.

Guidelines also state that children with sore throats should have their temperature taken, but 30% of GPs missed this step in the study.

“Another factor influencing the reported rate of adherence for GPs may be in the comprehensiveness of the documentation they keep,” Mr Hibbert said.

“CareTrack Kids analysed medical records and so if a GP did not fully record their interaction and advice, then it is considered not done. Not completing documentation fully may be as a result of time pressure, but does adversely affect the quality of medical records.”

The study showed that both GPs and EDs needed to be more active in referring some children for consideration of tonsillectomy.

“A child who suffers recurrent bouts of tonsillitis that disrupt their play and schooling, would benefit from a referral and yet a quarter are not referred,” Mr Hibbert said.

Otolaryngology–Head and Neck Surgery 2018, online August 28


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Jarrod McMaugh
7 months 12 days ago

“GPs might be prescribing antibiotics to meet parental expectations, he said.”

This is an illustrative example of when GPs have a conflict of interest (generated by a need to address parental expectations).

The rate of prescribings suggest that there are GPs who capitulate to this conflict of interest.

John Wilkins
John Wilkins
7 months 14 days ago
When I was going through med school in the 70’s we were told that a major reason for treating infected throats with antibiotics was the need to prevent Rheumatic Heart Disease. My understanding is that this disease is the result of inadequately treated and strep throat. A lingering strep throat being the most likely cause. Looking at the relative absence of Rheunatic Heart Disease in metropolitan Australia tells me that we aren’t doing a bad job. The reliance of temperature as an indication to treat might actually dissuade the treating of the very level of infection we need to be… Read more »