REATTENDANCE AND COMPLICATIONS IN A RANDOMIZED TRIAL OF PRESCRIBING STRATEGIES FOR SORE THROAT - THE MEDICALISING EFFECT OF PRESCRIBING ANTIBIOTICS

Objective: To assess the medicalising effect of prescribing antibiotic s for sore throat Setting: 11 general practices in England. Design: Ra ndomised trial of three approaches to sore throat: a 10 day prescripti on of antibiotics, no antibiotics, or a delayed prescription if the so re throat had not started to settle after three days. Patients: 716 pa tients aged 4 and over with sore throat and an abnormal physical sign: 84% had tonsillitis or pharyngitis. Outcome measures: Number and rate of patients making a first return with sore throat, pharyngitis, or t onsillitis. Early returns (within two weeks) and complications (otitis media, sinusitis, quinsy). Outcomes were documented in 675 subjects ( 94%). Results: Mean follow up time was similar (antibiotic group 1.07 years, other two groups 1.03 years). More of those initially prescribe d antibiotics initially returned to the surgery with sore throat (38% v 27%, adjusted hazard ratio for return 1.39, 95% confidence interval 1.03 to 1.89). Antibiotics prescribed for sore throat during the previ ous year had an additional effect (hazard ratio 1.69, 1.20 to 2.37). L onger duration of illness (> 5 days) was associated with increased ret urn within six weeks (hazard ratio 2.90, 1.70 to 4.92). Prior attendan ce with upper respiratory conditions was also associated with increase d reattendance. There was no difference between groups in early return (13/238 (5.5%) v 27/437 (6%)), or complications (2/236 (0.8%) v 3/434 (0.7%)). Conclusions: Complications and early return resulting from n o or delayed prescribing of antibiotics for sore throat are rare. Both current and previous prescribing for sore throat increase reattendanc e. To avoid medicalising a self limiting illness doctors should avoid antibiotics or offer a delayed prescription for most patients with sor e throat.