Defining the burden of antimicrobial prescribing in primary care attributable to sore throat

Project Details

The bacterium Group A Streptococcus (GAS) causes a range of infections. In developed countries, the most common of these is pharyngitis, or ‘sore throat’, particularly among children. The infection is treatable with antibiotics, and several studies and surveys in Australia and the United Kingdom have found that general practitioners (GPs) are more likely to prescribe antibiotics to a child presenting with a sore throat (or tonsillitis) or with suspected GAS pharyngitis compared to those without symptoms of pharyngitis. Australian GPs have also been found to frequently prescribe antibiotics for upper respiratory tract infections (URTIs), but as many of these are caused by viruses, antibiotics are ineffective. Misuse and unnecessary prescription of antibiotics has also contributed to a rise in bacterial resistance. There is a need to better understand GP antibiotic prescribing behaviour.

Patron ID: PAT001

Lead Organisation:

Doherty Institute

Chief Investigator

Professor Jodie McVernon

The aim of this project was to measure the relative frequency of upper respiratory tract infections and sore throat presentations and frequency of GP antibiotic prescribing for these patients.

The bacterium Group A Streptococcus (GAS) commonly causes 'sore throat', particularly among children. The infection is treatable with antibiotics. Some GPs frequently prescribe antibiotics for upper respiratory tract infections, however, as many are caused by viruses, antibiotics are ineffective. Misuse and unnecessary prescription of antibiotics has contributed to a rise in bacterial resistance. Better understanding of GP antibiotic prescribing behaviour is needed.

This project looked to inform strategies to improve prescribing practices. The information gained could provide an estimate of costs likely to be saved by a potential GAS vaccine and provide evidence to support its development.

Research Outcomes

As of 14/05/2023

• A short presentation was made to a small Strep A symposium at MCRI in December 2022.
• A peer reviewed paper targeting clinical/primary care journals is planned, it was first submitted to MJA but was rejected. We now plan to submit to BMC Primary Care.
• The work was been accepted as a poster presentation at the Communicable Diseases and Immunisation Conference (CDIC), held in Perth in June 2023.

April 2024 - Project complete

• We examined the prescription of antibiotics for sore throat during a visit to a Patron GP from 2013 – 2017. We found that antibiotic prescribing for sore throat was relatively common and broad spectrum antibiotics were often used despite Australian Therapeutic Guideline recommendations.
• Around 6% of GP visits were for an upper respiratory tract infection (URTI) with 0.8% of GP visits meeting the more specific criteria for sore throat.
• Two thirds (66.1%) of sore throat visits and just over one third (36.2%) of URTI visits resulted in antibiotic prescription. Among those with sore throat who received antibiotics, penicillin (the main recommended antibiotic for sore throat) was prescribed for only half (52.9%) of the cases.
• Broader spectrum antibiotics were prescribed more frequently in older age groups. Multiple sustained interventions are needed to reduce prescribing and promote antimicrobial stewardship.

Research Publications

‌Carville, K.S., Meagher, N., Abo, Y.-N., Jo-Anne Manski-Nankervis, Fielding, J., Steer, A., McVernon, J. and Price, D.J. (2024). Burden of antimicrobial prescribing in primary care attributable to sore throat: a retrospective cohort study of patient record data. BMC primary care, 25(1). doi:https://doi.org/10.1186/s12875-024-02371-y.