Sore Throat Treatment Guidelines are Fanning the Flames of Antimicrobial Resistance

Abstract

Sore throat represents a significant yet under-recognised battle in the war against antimicrobial resistance (AMR). It is one of the most common reasons people visit a doctor and approximately 60% walk away with a prescription for antibiotics.1 However, studies have indicated that 70–95% of all cases are viral2 and most patients would be better served with symptom relief. A systematic review of global sore throat management guidelines by members of the Global Respiratory Infection Partnership (GRIP) suggested the problem could be rooted in a focus on serious, yet increasingly rare, conditions, such as quinsy and acute rheumatic fever (ARF). While ARF can be a dangerous complication of Group A streptococci (GAS), which are identified in 15–30% of sore throat cases, the incidence of ARF is exceedingly rare in most parts of the world.3 All but one of the 36 identified guideline documents discussed antibiotic therapy and less than two-thirds advocated the use of laboratory tests to confirm GAS. Just 50% gave advice on symptom relief, which evidence suggests is the most appropriate approach in most cases.4 Dr Martin Duerden, lecturer in therapeutics and prescribing at Cardiff University, Cardiff, UK, member of the GRIP, recently retired general practitioner, and co-author of the review, believes countries should re-evaluate their guidelines. In this interview, Dr Duerden talks about the role of fit-for-purpose sore throat guidelines in antimicrobial stewardship, the importance of appropriate symptom relief, and how coronavirus disease (COVID-19) could represent an opportunity for change.