Antibiotics and sore throat

Antibiotics are indicated in a small proportion of sore throats and have been shown to reduce the duration of symptoms by an average of 16 hours. Despite efforts to reduce usage in sore throats they are prescribed to as many as 60 per cent of patients who attend general practice with a sore throat.  

The NICE guideline on antimicrobial prescribing includes a useful visual summary of its recommendations on antibiotic use in acute sore throat. 

Where pharmacists are authorised to make an NHS supply of antibiotics under a PGD there is the opportunity to reduce their unnecessary use and reinforce antimicrobial stewardship. The use of clinical scoring systems and evidence-based communication techniques are key to appropriate use of antibiotics.  

NICE makes specific recommendations on which antibiotic to prescribe – normally this would be phenoxymethylpenicillin (penicillin-V), or clarithromycin in those with penicillin allergy. 

Service-specific PGDs define the inclusion and exclusion criteria for different antibiotics (see later). 

The main contraindication is allergy/hypersensitivity to an antibiotic – usually penicillin.  

Acceptable sources of allergy information include the individual, their carer/parent/guardian, or their National Care Record (but bear in mind these sources are not always accurate).  

Reducing antibiotic usage 

Overuse of antibiotics contributes to antibiotic resistance, and antibiotics can also cause side-effects such as diarrhoea, nausea and vomiting. 

Where the decision is not to give an antibiotic there is good evidence that many patients are satisfied if they are listened to carefully, are examined thoroughly, and provided with an explanation with alternatives recommended for relieving symptoms. 

Studies in general practice found there is often a mismatch between what the GP thinks the patient wants and what the patient actually wants, and this may also happen with pharmacist consultations.  

The Royal College of General Practitioners has developed the CHESTSSS consultation structure as part of the TARGET toolkit dealing with “Finding the right words”, based on the evidence for communication strategies that work.