Context

Sore throat accounted for 1.9% of all visits to emergency departments (EDs) in the USA in 2006 [1]. This figure represents a small percentage of the total disease prevalence as only about 15% of people with an upper respiratory tract infection seek medical care [2].

Most sore throats have an unknown or viral aetiology but group A β haemolytic streptococcus (GABHS) is identified as the infecting agent in approximately 5–15% of all cases [3]. GABHS infection may be complicated by significant sequelae such as:

• Rheumatic fever
• Peritonsillar abscess (quinsy)
• Post-streptococcal glomerulonephritis

Even though the vast majority of patients with a sore throat have a benign, self-limiting course, one study found that 64% of primary care patients in the UK are prescribed antibiotics for a sore throat [4].

Learning bite

Although the minority of sore throats are caused by bacterial infection, almost two-thirds of patients are managed with a course of antibiotics.

A recent Cochrane review showed that antibiotics give only modest symptomatic relief and only significantly reduce the risk of serious complications in areas where such complications e.g. rheumatic fever are common [16].