Antibiotics for treatment of sore throat in children and adults
Information
- DOI:
- https://doi.org/10.1002/14651858.CD000023.pub5Copy DOI
- Database:
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- Cochrane Database of Systematic Reviews
- Version published:
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- 09 December 2021see what's new
- Type:
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- Intervention
- Stage:
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- Review
- Cochrane Editorial Group:
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Cochrane Acute Respiratory Infections Group
- Copyright:
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- Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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Authors
Contributions of authors
Chris Del Mar first conceived the review, presenting it as a meta‐analysis in a journal (Del Mar 1992a; Del Mar 1992b). It was subsequently improved and modified for the Cochrane Library with Paul Glasziou (who improved the subgroup analyses) and Anneliese Spinks (who updated the searches and completed the analyses).
Sources of support
Internal sources
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No sources of support provided
External sources
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No sources of support provided
Declarations of interest
Anneliese Spinks has declared that they have no conflict of interest.
Paul Glasziou is on the board of Therapeutic Guidelines Limited and holds a research grant from the National Health and Medical Research Council on antibiotic resistance.
Chris Del Mar has received funding from the National Health and Medical Research Council for antibiotic resistance and from the Cochrane Acute Respiratory Infections Group and some consultancies (GSK for advice about vaccines for otitis media, and a local pharmaceutical company contemplating analgesic ear drops for otitis media).
Acknowledgements
A previous update was completed with the help of a Glaxo‐sponsored educational support grant from the Australasian Cochrane Centre. The 2006 update was supported by a grant from the UK NHS through the Cochrane Acute Respiratory Infections Group, based in Australia (at Bond University).
Thanks to Prof Jim Dickinson for helpful suggestions about dividing the studies into early and late last century in order to evaluate whether the pathogenesis of this illness, and/or its sequelae, have changed with time. Thanks to Ian Thomas and Michael Thomas for research assistance. Thanks to Beth Clewer and Katie Farmer, who in January 1999 drew our attention to mistakes in the data extraction by their careful checking of original studies as part of their medical student project at the University of Bristol Medical School. The authors wish to thank the following people for commenting on the 2006 update of the review: Craig Mellis, Mark Jones, and Tom Fahey; and the following people for commenting on the 2021 update: Dr Rashmi Ranjan Das, Additional Professor, Department of Pediatrics, AIIMS Bhubaneswar, India; Maria Isabel Costa, Universidade Fernando Pessoa, Portugal; Jonathan M Fuchs, FACHE, Chief Operating Officer, Kidder Street Consulting Group; Maryam Panahi, Teresa Neeman, and Tom Fahey.
Version history
| Published | Title | Stage | Authors | Version |
| 2021 Dec 09 | Antibiotics for treatment of sore throat in children and adults | Review | Anneliese Spinks, Paul P Glasziou, Chris B Del Mar | |
| 2013 Nov 05 | Antibiotics for sore throat | Review | Anneliese Spinks, Paul P Glasziou, Chris B Del Mar | |
| 2006 Oct 18 | Antibiotics for sore throat | Review | Anneliese Spinks, Paul P Glasziou, Chris B Del Mar | |
| 2004 Apr 19 | Antibiotics for sore throat | Review | Chris Del Mar, Paul P Glasziou, Anneliese Spinks | |
| 2000 Jun 28 | Antibiotics for sore throat | Review | Chris Del Mar, Paul P Glasziou, Anneliese B Spinks | |
Differences between protocol and review
There were no substantial differences in the methods of data extraction or analysis between earlier versions of this review and the current 2021 update.
We revised decision making and reporting for risk of bias items and certainty of evidence levels in this update, as recommended by the Cochrane Acute Respiratory Infections Group in order to comply with current Cochrane methodological standards.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Adult; Child; Humans; Infant;
PICOs
Study flow diagram for the 2021 review update.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Funnel plot of comparison: 1 Antibiotics versus control for the treatment of sore throats: symptom of sore throat, outcome: 1.1 Symptom of sore throat on day 3.
Funnel plot of comparison: 1 Antibiotics versus control for the treatment of sore throat: symptom of sore throat, outcome: 1.6 Symptom of sore throat at 1 week (6 to 8 days).
Funnel plot of comparison: 4 Antibiotics versus control for the treatment of sore throat: incidence of complications, outcome: 4.1 Incidence of acute rheumatic fever within 2 months. Rheumatic fever defined by clinical diagnosis.
Funnel plot of comparison: 4 Antibiotics versus control for the treatment of sore throat: incidence of complications, outcome: 4.4 Incidence of otitis media within 14 days. Otitis media defined by clinical diagnosis.
Comparison 1: Antibiotics versus control for the treatment of sore throat: symptoms of sore throat, Outcome 1: Symptom of sore throat on day 3
Comparison 1: Antibiotics versus control for the treatment of sore throat: symptoms of sore throat, Outcome 2: Symptom of sore throat on day 3: early (pre‐1975) versus late studies (post‐1975)
Comparison 1: Antibiotics versus control for the treatment of sore throat: symptoms of sore throat, Outcome 3: Symptom of sore throat on day 3: blind versus unblinded studies
Comparison 1: Antibiotics versus control for the treatment of sore throat: symptoms of sore throat, Outcome 4: Symptom of sore throat on day 3: antipyretics versus no antipyretics
Comparison 1: Antibiotics versus control for the treatment of sore throat: symptoms of sore throat, Outcome 5: Symptom of sore throat on day 3: GABHS‐positive throat swab, negative swab, untested/inseparable
Comparison 1: Antibiotics versus control for the treatment of sore throat: symptoms of sore throat, Outcome 6: Symptom of sore throat at 1 week (6 to 8 days)
Comparison 1: Antibiotics versus control for the treatment of sore throat: symptoms of sore throat, Outcome 7: Symptom of sore throat at 1 week (6 to 8 days): early (pre‐1975) versus late (post‐1975)
Comparison 1: Antibiotics versus control for the treatment of sore throat: symptoms of sore throat, Outcome 8: Symptom of sore throat at 1 week (6 to 8 days): blind versus unblinded studies
Comparison 1: Antibiotics versus control for the treatment of sore throat: symptoms of sore throat, Outcome 9: Symptom of sore throat at 1 week (6 to 8 days): GABHS‐positive throat swab, GABHS‐negative swab
Comparison 2: Antibiotics versus control for the treatment of sore throat: symptoms of fever, Outcome 1: Symptom of fever on day 3
Comparison 2: Antibiotics versus control for the treatment of sore throat: symptoms of fever, Outcome 2: Symptom of fever on day 3: blinded versus unblinded studies
Comparison 2: Antibiotics versus control for the treatment of sore throat: symptoms of fever, Outcome 3: Symptom of fever on day 3: children compared with adults
Comparison 2: Antibiotics versus control for the treatment of sore throat: symptoms of fever, Outcome 4: Symptom of fever at 1 week (6 to 8 days)
Comparison 3: Antibiotics versus control for the treatment of sore throat: symptoms of headache, Outcome 1: Symptom of headache on day 3
Comparison 3: Antibiotics versus control for the treatment of sore throat: symptoms of headache, Outcome 2: Symptom of headache on day 3: blinded versus unblinded studies
Comparison 4: Antibiotics versus control for the treatment of sore throat: incidence of complications, Outcome 1: Incidence of acute rheumatic fever within 2 months. Rheumatic fever defined by clinical diagnosis
Comparison 4: Antibiotics versus control for the treatment of sore throat: incidence of complications, Outcome 2: Incidence of acute rheumatic fever within 2 months. Penicillin versus placebo
Comparison 4: Antibiotics versus control for the treatment of sore throat: incidence of complications, Outcome 3: Incidence of acute rheumatic fever within 2 months: early (pre‐1975) versus late studies (post‐1975)
Comparison 4: Antibiotics versus control for the treatment of sore throat: incidence of complications, Outcome 4: Incidence of otitis media within 14 days. Otitis media defined by clinical diagnosis
Comparison 4: Antibiotics versus control for the treatment of sore throat: incidence of complications, Outcome 5: Incidence of otitis media within 14 days: early (pre‐1975) versus late studies (post‐1975)
Comparison 4: Antibiotics versus control for the treatment of sore throat: incidence of complications, Outcome 6: Incidence of sinusitis within 14 days. Sinusitis defined by clinical diagnosis
Comparison 4: Antibiotics versus control for the treatment of sore throat: incidence of complications, Outcome 7: Incidence of quinsy within 2 months. Quinsy defined by clinical diagnosis
Comparison 4: Antibiotics versus control for the treatment of sore throat: incidence of complications, Outcome 8: Incidence of acute glomerulonephritis within 1 month. Acute glomerulonephritis defined by clinical diagnosis
| Antibiotics compared with control for sore throat | ||||||
| Patient or population: adults and children presenting with sore throat Settings: community Intervention: antibiotics Comparison: control (placebo or no treatment) | ||||||
| Outcomes | Anticipated absolute effects (95% CI) | Relative effect | No. of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Risk with control | Risk with antibiotics
| |||||
| Sore throat: day 3 | 660 | 462 (396 to 528) | RR 0.70 (0.60 to 0.80) | 3730 | ⊕⊕⊕⊝ |
|
| Sore throat: 1 week | 190 | 95 (65 to 143) | RR 0.50 (0.34 to 0.75) | 3083 | ⊕⊕⊕⊝ |
|
| Fever: day 3 | 197 | 148 (104 to 211) | RR 0.75 (0.53 to 1.07) | 1443 | ⊕⊕⊕⊕ |
|
| Headache: day 3 | 421 | 206 (143 to 295) | RR 0.49 (0.34 to 0.70) | 1020 | ⊕⊕⊕⊕ |
|
| Rheumatic fever (within 2 months, clinical diagnosis) | 190 | 61 (34 to 110) | Peto OR 0.32 (0.18 to 0.58) | 12,132 | ⊕⊕⊕⊝ | Based largely on risk in pre‐1960 trials |
| Glomerulonephritis (within 1 month, clinical diagnosis) | 1 | 0 (0 to 2) | Peto OR 0.07 (0.00 to 1.32) | 5147 | ⊕⊝⊝⊝ | Sparse data: 2 cases only in the placebo group |
| Quinsy (within 2 months, clinical diagnosis) | 23 | 3 (1 to 11) | Peto OR 0.16 (0.07 to 0.35) | 2367 | ⊕⊕⊕⊕ |
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| Otitis media (within 14 days, clinical diagnosis) | 20 | 5 (3 to 11) | Peto OR 0.21 (0.11 to 0.40) | 3646 | ⊕⊕⊕⊕ |
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| The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level for high level of heterogeneity. | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Symptom of sore throat on day 3 Show forest plot | 16 | 3730 | Risk Ratio (M‐H, Random, 95% CI) | 0.70 [0.60, 0.80] |
| 1.2 Symptom of sore throat on day 3: early (pre‐1975) versus late studies (post‐1975) Show forest plot | 16 | 3730 | Risk Ratio (M‐H, Random, 95% CI) | 0.70 [0.60, 0.80] |
| 1.2.1 Symptom of sore throat on day 3: early (pre‐1975) studies | 6 | 1141 | Risk Ratio (M‐H, Random, 95% CI) | 0.62 [0.56, 0.69] |
| 1.2.2 Symptom of sore throat on day 3: late (post‐1975) studies | 10 | 2589 | Risk Ratio (M‐H, Random, 95% CI) | 0.72 [0.60, 0.88] |
| 1.3 Symptom of sore throat on day 3: blind versus unblinded studies Show forest plot | 16 | 3730 | Risk Ratio (M‐H, Random, 95% CI) | 0.70 [0.60, 0.80] |
| 1.3.1 Symptom of sore throat on day 3: blinded studies | 12 | 2662 | Risk Ratio (M‐H, Random, 95% CI) | 0.65 [0.54, 0.78] |
| 1.3.2 Symptom of sore throat on day 3: unblinded studies | 4 | 1068 | Risk Ratio (M‐H, Random, 95% CI) | 0.81 [0.65, 1.01] |
| 1.4 Symptom of sore throat on day 3: antipyretics versus no antipyretics Show forest plot | 5 | 1137 | Risk Ratio (M‐H, Random, 95% CI) | 0.58 [0.48, 0.70] |
| 1.4.1 Symptom of sore throat on day 3: antipyretics administered | 3 | 455 | Risk Ratio (M‐H, Random, 95% CI) | 0.52 [0.33, 0.81] |
| 1.4.2 Symptom of sore throat on day 3: no antipyretics administered | 2 | 682 | Risk Ratio (M‐H, Random, 95% CI) | 0.62 [0.55, 0.70] |
| 1.5 Symptom of sore throat on day 3: GABHS‐positive throat swab, negative swab, untested/inseparable Show forest plot | 15 | 3600 | Risk Ratio (M‐H, Random, 95% CI) | 0.68 [0.59, 0.78] |
| 1.5.1 Symptom of sore throat on day 3: GABHS‐positive throat swab | 11 | 1839 | Risk Ratio (M‐H, Random, 95% CI) | 0.58 [0.48, 0.71] |
| 1.5.2 Symptom of sore throat on day 3: GABHS‐negative throat swab | 6 | 736 | Risk Ratio (M‐H, Random, 95% CI) | 0.78 [0.63, 0.97] |
| 1.5.3 Symptom of sore throat on day 3: untested for GABHS culture or combined, inseparable data | 3 | 1025 | Risk Ratio (M‐H, Random, 95% CI) | 0.89 [0.80, 1.00] |
| 1.6 Symptom of sore throat at 1 week (6 to 8 days) Show forest plot | 14 | 3083 | Risk Ratio (M‐H, Random, 95% CI) | 0.50 [0.34, 0.75] |
| 1.7 Symptom of sore throat at 1 week (6 to 8 days): early (pre‐1975) versus late (post‐1975) Show forest plot | 14 | 3083 | Risk Ratio (M‐H, Random, 95% CI) | 0.50 [0.34, 0.75] |
| 1.7.1 Symptom of sore throat at 1 week (6 to 8 days): early (pre‐1975) studies | 6 | 1140 | Risk Ratio (M‐H, Random, 95% CI) | 0.14 [0.08, 0.27] |
| 1.7.2 Symptom of sore throat at 1 week (6 to 8 days): late (post‐1975) studies | 8 | 1943 | Risk Ratio (M‐H, Random, 95% CI) | 0.73 [0.55, 0.97] |
| 1.8 Symptom of sore throat at 1 week (6 to 8 days): blind versus unblinded studies Show forest plot | 14 | 3053 | Risk Ratio (M‐H, Random, 95% CI) | 0.57 [0.39, 0.82] |
| 1.8.1 Symptom of sore throat at 1 week (6 to 8 days): blinded studies | 9 | 1616 | Risk Ratio (M‐H, Random, 95% CI) | 0.62 [0.38, 1.03] |
| 1.8.2 Symptom of sore throat at 1 week (6 to 8 days): unblinded studies | 5 | 1437 | Risk Ratio (M‐H, Random, 95% CI) | 0.43 [0.20, 0.91] |
| 1.9 Symptom of sore throat at 1 week (6 to 8 days): GABHS‐positive throat swab, GABHS‐negative swab Show forest plot | 12 | 2524 | Risk Ratio (M‐H, Random, 95% CI) | 0.48 [0.29, 0.80] |
| 1.9.1 Symptom of sore throat at 1 week (6 to 8 days): GABHS‐positive throat swab | 7 | 1117 | Risk Ratio (M‐H, Random, 95% CI) | 0.29 [0.12, 0.70] |
| 1.9.2 Symptom of sore throat at 1 week (6 to 8 days): GABHS‐negative throat swab | 5 | 541 | Risk Ratio (M‐H, Random, 95% CI) | 0.73 [0.50, 1.07] |
| 1.9.3 Symptom of sore throat at 1 week (6 to 8 days): GABHS untested | 3 | 866 | Risk Ratio (M‐H, Random, 95% CI) | 0.35 [0.03, 4.47] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Symptom of fever on day 3 Show forest plot | 8 | 1443 | Risk Ratio (M‐H, Random, 95% CI) | 0.75 [0.53, 1.07] |
| 2.2 Symptom of fever on day 3: blinded versus unblinded studies Show forest plot | 8 | 1443 | Risk Ratio (M‐H, Random, 95% CI) | 0.75 [0.53, 1.07] |
| 2.2.1 Symptom of fever on day 3: blinded studies | 4 | 703 | Risk Ratio (M‐H, Random, 95% CI) | 0.82 [0.54, 1.23] |
| 2.2.2 Symptom of fever on day 3: unblinded studies | 4 | 740 | Risk Ratio (M‐H, Random, 95% CI) | 0.72 [0.43, 1.21] |
| 2.3 Symptom of fever on day 3: children compared with adults Show forest plot | 5 | 766 | Risk Ratio (M‐H, Random, 95% CI) | 0.63 [0.31, 1.26] |
| 2.3.1 Symptom of fever on day 3: children | 2 | 61 | Risk Ratio (M‐H, Random, 95% CI) | 1.27 [0.76, 2.13] |
| 2.3.2 Symptom of fever on day 3: adults | 3 | 705 | Risk Ratio (M‐H, Random, 95% CI) | 0.48 [0.21, 1.10] |
| 2.4 Symptom of fever at 1 week (6 to 8 days) Show forest plot | 4 | 886 | Risk Ratio (M‐H, Random, 95% CI) | 0.91 [0.55, 1.52] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Symptom of headache on day 3 Show forest plot | 4 | 1020 | Risk Ratio (M‐H, Random, 95% CI) | 0.49 [0.34, 0.70] |
| 3.2 Symptom of headache on day 3: blinded versus unblinded studies Show forest plot | 4 | 1020 | Risk Ratio (M‐H, Random, 95% CI) | 0.49 [0.34, 0.70] |
| 3.2.1 Symptom of headache on day 3: blinded studies | 2 | 436 | Risk Ratio (M‐H, Random, 95% CI) | 0.33 [0.09, 1.20] |
| 3.2.2 Symptom of headache on day 3: unblinded studies | 2 | 584 | Risk Ratio (M‐H, Random, 95% CI) | 0.57 [0.45, 0.72] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Incidence of acute rheumatic fever within 2 months. Rheumatic fever defined by clinical diagnosis Show forest plot | 17 | 12132 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.36 [0.26, 0.50] |
| 4.2 Incidence of acute rheumatic fever within 2 months. Penicillin versus placebo Show forest plot | 14 | 8407 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.26 [0.18, 0.40] |
| 4.3 Incidence of acute rheumatic fever within 2 months: early (pre‐1975) versus late studies (post‐1975) Show forest plot | 15 | 9984 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.30 [0.20, 0.45] |
| 4.3.1 Incidence of acute rheumatic fever within 2 months: early (pre‐1975) studies | 10 | 7617 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.30 [0.20, 0.45] |
| 4.3.2 Incidence of acute rheumatic fever within 2 months: late (post‐1975) studies | 5 | 2367 | Peto Odds Ratio (Peto, Fixed, 95% CI) | Not estimable |
| 4.4 Incidence of otitis media within 14 days. Otitis media defined by clinical diagnosis Show forest plot | 10 | 3646 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.21 [0.11, 0.40] |
| 4.5 Incidence of otitis media within 14 days: early (pre‐1975) versus late studies (post‐1975) Show forest plot | 10 | 3646 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.21 [0.11, 0.40] |
| 4.5.1 Incidence of otitis media within 14 days: early (pre‐1975) studies | 5 | 1837 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.25 [0.12, 0.52] |
| 4.5.2 Incidence of otitis media within 14 days: late (post‐1975) studies | 5 | 1809 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.05 [0.01, 0.31] |
| 4.6 Incidence of sinusitis within 14 days. Sinusitis defined by clinical diagnosis Show forest plot | 7 | 2270 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.46 [0.10, 2.05] |
| 4.7 Incidence of quinsy within 2 months. Quinsy defined by clinical diagnosis Show forest plot | 7 | 2367 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.16 [0.07, 0.35] |
| 4.8 Incidence of acute glomerulonephritis within 1 month. Acute glomerulonephritis defined by clinical diagnosis Show forest plot | 10 | 5147 | Peto Odds Ratio (Peto, Fixed, 95% CI) | 0.07 [0.00, 1.32] |
