OPEN RANDOMIZED TRIAL OF PRESCRIBING STRATEGIES IN MANAGING SORE THROAT

Objective: To assess three prescribing strategies for sore throat Desi gn: Randomised follow up study. Setting: 11 general practices in the S outh and West region. Subjects: 716 patients aged 4 years and over wit h sore throat and an abnormal physical sign in the throat; 84% had ton sillitis or pharyngitis. Patients were randomised to three groups: pre scription for antibiotics for 10 days (group 1, 246 patients); no pres cription (group 2, 230 patients); or prescription for antibiotics if s ymptoms were not starting to settle after three days (group 3; 238 pat ients). Main outcome measures: Duration of symptoms; satisfaction and compliance with and perceived efficacy of antibiotics; time off school or work. Outcomes were documented in 582 subjects (81%). Results: Med ian duration of antibiotic use differed significantly in the three gro ups (10 v 0 v 0 days, P<0.001); 69% of patients in group 3 did not use their prescription, The proportion of patients better by day 3 did no t differ significantly (37% v 35% v 30%, P=0.28), nor did the duration of illness (median 4 v 5 v 5 days, P=0.39), days off work or school ( median 2 v 2 v 1, P=0.13), or proportion of patients satisfied (96% v 90% v 93%, P=0.09), although group 1 had fewer days of fever (median 1 v 2 v 2 days, P=0.04). More patients in group 1 thought the antibioti cs were effective (87% v 55% v 60%, P<0.001) and intended coming to th e doctor in future attacks (79% v 54% v 57%, P<0.001). ''Legitimation' ' of illness-to explain to work or school (60%) or family or friends ( 37%)-was an important reason for consultation. Patients who were more satisfied got better more quickly, and satisfaction related strongly t o how well the doctor dealt with patient's concerns. Conclusion: Presc ribing antibiotics for sore throat only marginally affects the resolut ion of symptoms but enhances belief in antibiotics and intention to co nsult in future when compared with the acceptable strategies of no pre scription or delayed prescription. Psychosocial factors are important in the decision to see a general practitioner and in predicting the du ration of illness.