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Sore Throats: Who Gets Antibiotics?

Most patients that walk into a doctor’s office with a sore throat expect to be given something to make them feel better. Many are surprised, and even angry, when they are told that they will not be walking out with antibiotics. How do physicians, like myself, make this decision? Is it simply up to my whim or current mood that day? In fact, there are some fairly simple rules that help me determine who will benefit from antibiotics. If armed with this information in advance, patients can have much more realistic expectations of what their physician will tell them in the office.

Infection or Not

Many falsely assume that pain in their throat means they have an infection (or pharyngitis). This is not necessarily the case as there are multiple non-infectious reasons to have a sore throat. I usually ask patients about symptoms such as fever, throat drainage, and itchy or watery eyes to determine if they indeed have an infection or something else such as allergies. If I determine that the patient does not have an infection, then I will simply prescribe symptomatic relief such with medicines such as menthol lozenges, Chloraseptic spray, or salt water gargles.

Bacterial vs. Viral

After I decide that a patient has pharyngitis, then the next step is to determine if a bacteria or virus is to blame. Bacterial infection (more commonly called strep throat) would warrant antibiotics while viral infection calls for rest, fluids, salt gargles, and symptomatic treatment like Tylenol. Fortunately, criteria have been developed to help make this determination, termed the Centor criteria. These are named for the investigator that developed the criteria (original article here). The criteria are as follows:

Temperature greater than 100.4 degrees Fahrenheit

Tonsillar exudates (plaques that can be seen on the tonsils)

Tender, enlarged neck lymph nodes

No cough present

If one or no criteria are present, then it is likely viral. If two or three are present, then the patient should undergo a rapid strep test to determine if antibiotics are needed. If all four criteria are present, then the patient can simply be treated with antibiotics.

Believe it or not, it is that simple in many cases. With this information in hand, you should be much better equipped to have a good conversation with your doctor about your illness. Try not to smile too much when your doctor starts to go over this information with you. He doesn’t know that you’re already an expert!

Robert A Glass