Do Patients with Pharyngitis Need to Be Treated with Antibiotics?

Acute pharyngitis SHOULD NOT typically be treated with antibiotics. The great majority of cases are viral in origin

  • MYTH#1: Antibiotics reduce symptomology – NO THEY DON’T (Steroids DO)
  • MYTH #2: Antibiotics reduce the rate of suppurative complications – NO THEY DON’T (Little 2013).

Clinical Bottom Line:

We are far more likely to HARM patients with pharyngitis by giving antibiotics than to help them

  • 1 in 10 patients will develop antibiotic associated diarrhea (some of these will be C. diff)
  • Severe allergic reactions occur in 0.24% of patients – This means that out of 10 million patients treated with antibiotics, as many as 24,000 of them will have fatal or near-fatal allergic reactions.

Thus, it’s important to determine if the benefits of antibiotic treatment outweigh the risks.

EM Don’ts

  1. Avoid CT of the head in asymptomatic adult patients in the emergency department with syncope, insignificant trauma and a normal neurological evaluation.
  2. Avoid CT pulmonary angiography in emergency department patients with a low-pretest probability of pulmonary embolism and either a negative Pulmonary Embolism Rule-Out Criteria (PERC) or a negative D-dimer.
  3. Avoid lumbar spine imaging in the emergency department for adults with atraumatic back pain unless the patient has severe or progressive neurologic deficits or is suspected of having a serious underlying condition, such as vertebral infection or cancer with bony metastasis.
  4. Avoid prescribing antibiotics in the emergency department for uncomplicated sinusitis.
  5. Avoid ordering CT of the abdomen and pelvis in young otherwise health emergency department patients with known histories of ureterolithiasis presenting with symptoms consistent with uncomplicated kidney stones.