Treatment of Acute Sore Throat in General Practice

Abstract

Sore throat is a common complaint in general practice, but doctors do not agree on the best method of treat ment. Earlier trials of sulphonamide drugs gave con flicting results (Rhoads and Afremow, 1940; Freis, 1944; Clodfelter, 1945; Commission on Acute Respira tory Disease, 1945), but more recently MacDonald and Watson (1951) and Landsman and her colleagues (1951) both concluded that the sulphonamide treatment they used was not effective. As with many of the earlier trials, the patients treated by MacDonald and Watson were young Service men, and their findings are not necessarily applicable toyounger patients or to those living in their own homes. Furthermore, although there was little difference between the average duration of symptoms and signs in treated and control cases, a statistically significant preponderance of patients making a good recovery after 72 hours' treatment had received sulphonamide. Landsman's patients were of all ages and were treated in general practice, but the total number of cases was too small to put the question beyond doubt. Evaluation of penicillin in the treatment of sore throat has been bacteriological rather than clinical. Investigations by Plummer et al. (1945), Keith et al. (1945), and Denny et al. (1953) confirmed that penicillin eradicated streptococci from the throat and strongly sug gested that clinical recovery was also accelerated. A controlled trial of penicillin in sore throat in this country was reported by Gardner (1953), who treated 102 cases of food-borne streptococcal tonsillitis with penicillin, sulphadimidine ( sulphamezathine ), or aspirin. The average recovery time in the penicillin group was similar to that in the sulphadimidine group and about half as long as that in the aspirin group, but as the numbers were small the differences were not statistically significant. The problem that faces the general practitioner, how ever, is not the treatment of streptococcal tonsillitis but of acute febrile sore throats, of which only a proportion may be streptococcal. Though certain broad differences between large groups of cases of streptococcal and non streptococcal sore throat have been observed (Com mission on Acute Respiratory Diseases, 1944, 1947; Landsman et al., 1951), the classification of an individual case on clinical grounds alone is not practicable. Pro bably most doctors prescribe intramuscular penicillin if the illness is severe, but find more difficulty in deciding whether to use penicillin or sulphonamide, with the atten dant risk and discomfort, for less severe infections. Because it was felt that no adequate evaluation of sul phonamide or of oral penicillin in the treatment of cases of this kind had been made, the investigation described below was undertaken.