Prescribing antibiotics for sore throat: adherence to guidelines in patients admitted to hospital

We prospectively studied patients referred to secondary care with acute tonsillitis, peritonsillar cellulitis and quinsy (peritonsillar abscess) to see if recommended treatment guidelines were being followed and whether antibiotic resistance was contributing to admission.

Prospective observational study in a university teaching hospital of 90 consecutive patients admitted to secondary care over an 18 month period with acute tonsillitis, peritonsillar cellulitis or quinsy were studied. The geographical distribution by postcode, pre-admission history and treatment of each patient was recorded. The patients' general practitioners (GPs) were questioned about the patients' history, their use of antibiotics and prescribing guidelines and a patient questionnaire was completed. The result of hospital admission including throat swabs and blood cultures were recorded together with their treatment and outcome.

58% (n = 28) of patients who were prescribed antibiotics before admission received an inadequate dose or inappropriate antibiotic. Only 56% (n = 45) of GPs said they used guidelines for the treatment of acute sore throat. In 34 cases an organism was isolated, with 33 (97%) being sensitive to penicillin. No resistant organisms were isolated. Hospital doctors prescribed antibiotics contrary to guidelines in 39% (n = 35) of cases.

Antibiotic resistance was not demonstrated in this study. Adherence to guidelines for prescribing antibiotics in patients with features of group A beta-haemolytic streptococcal sore throat is poor. Information support may help to improve prescribing.