Pharyngitis is a common reason for pediatric health care visits. While viral infections account for the majority of pharyngitis episodes, group A Streptococcus (GAS) is implicated in approximately 37% of episodes among children. Antimicrobial treatment of GAS pharyngitis can shorten illness duration, prevent complications, and minimize transmission to others. Evidence-based guidelines for GAS pharyngitis recommend narrow-spectrum penicillins (amoxicillin or penicillin) as first-line therapy; they are effective and GAS is universally susceptible to these agents.

In a recent study in adults with sore throat, most patients received broader-spectrum antibiotics, commonly macrolides, instead of first-line therapy. We characterized the frequency and appropriateness of antibiotic prescribing for pharyngitis in children.

If kids have strep throat, then, sure, they should get antibiotics. Penicillin works great. But only about a third of sore throats are caused by strep. The rest are pretty much viral, and no antibiotics should be used for that.

These researchers used data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from 1997 through 2010 to look at visits to the doctor for sore throat. They also looked at whether antibiotics were prescribed.

They found almost 12 million pediatric visits for pharyngitis. That’s about 200 per 1000 children (sore throat is common!). About 70% of the visits were for kids less than 12 years of age.

You know where this is going, right?

Antibiotics were prescribed in 60% of the visits. Penicillin, which is all that’s needed for Group A strep, was used 61% of the time, decreasing from 65% at the beginning of the study to 52% at the end.

Since only about a third of these visits likely needed any antibiotic at all, that means that many of the 60% of kids who were given antibiotics didn’t need them. Since penicillin is all that’s required to treat strep throat, that means that many of the kids given antibiotics were prescribed a drug that’s way more broad-spectrum than needed.

Even when we overtreat, we overtreat.