Abstract
Background
Sore throat is a common respiratory tract symptom responsible for 6% of children's visits to pediatricians or family physicians. Even though sore throat is usually selfβlimiting, antibiotics are often prescribed in hopes of decreasing symptom length and the risk of developing sequelae. However, antibiotic overβprescription could lead to adverse events in individuals and bacterial resistance in the community, so the efficacy and safety of antibiotics must first be established, and alternative treatment options should also be investigated.
Objectives
This overview of reviews aims to synthesize evidence from the Cochrane Database of Systematic Reviews (CDSR) on the efficacy and safety of different antibiotic treatment strategies (standard antibiotics, delayed antibiotics, shortβduration antibiotics and different types of antibiotics) to improve symptoms of sore throat in children and adolescents. The efficacy and safety of two other treatments, steroids and Chinese herbal medicine, are also investigated.
Methods
Issue 1, 2011 of the CDSR was searched for all reviews examining the treatment of sore throat and disorders which commonly have sore throat as part of their clinical presentation. We also searched for reviews examining the prevention of important sequelae of sore throat. All systematic reviews examining pharmacologic or nonβpharmacologic treatments in children were identified, and data were extracted, compiled into tables and synthesized using quantitative and qualitative methods.
Main results
Data pertaining to sore throat in children and adolescents were extracted from seven Cochrane reviews. Antibiotics provided only modest benefit over placebo for symptoms of sore throat and fever. Immediate versus delayed prescription of antibiotics resulted in a 58% decrease in severity of pain due to sore throat on day three (RR: 0.42; 95% CI: 0.33, 0.54), and a significant, moderate decrease in fever on day three (SMD: β 0.53; 95% CI: β 0.74, β 0.31). Most studies of macrolides, cephalosporins and carbacephem showed no significant benefit over oral penicillin for resolution of symptoms, but in two trials a short course of a cephalosporin compared to oral penicillin led to modest decreases in both sore throat (half a day; MD: β 0.50; 95% CI: β 0.78, β 0.22) and fever (seven hours; MD: β 0.30; 95% CI: β 0.45, β 0.14). Steroids compared to placebo decreased symptoms of sore throat in children with infectious mononucleosis at 12 hours (RR: 0.54; 95% CI: 0.30, 0.99) but not at any other measured time points. A higher rate of vomiting was associated with delayed antibiotics (RR: 0.07; 95% CI: 0.03, 0.20); vomiting, diarrhea and abdominal pain were associated with shortβduration antibiotics (RR: 1.74; 95% CI: 1.31, 2.32); and overall adverse effects were associated with macrolides (RR: 2.19; 95% CI: 1.04, 4.61). Trials involving Chinese herbal medications for sore throat were of low quality and no good evidence for the use of these agents was available.
Antibiotics compared to placebo were associated with lower rates of acute rheumatic fever, but the difference was not statistically significant when only pediatric data were included (RR: 0.20: 95% CI: 0.01, 4.18). One review examining the secondary prevention of rheumatic fever found that intramuscular versus oral penicillin reduced the recurrence of rheumatic fever by 92% (RR: 0.08; 95% CI: 0.04, 0.18) and significantly reduced the number of participants who developed streptococcal throat infections (RR: 0.22; 95% CI: 0.17, 0.27; I^2^: 81%).
Authors' Conclusions
Evidence from the CDSR suggests that antibiotics provide only modest improvements in symptoms of sore throat in children and adolescents. If antibiotics are prescribed, macrolides are less ideal compared to other agents, and there is some evidence that a short course of a newer cephalosporin may be slightly better than a standard course of penicillin. Any potential benefit of antibiotic treatment must be weighed against the cost of treatment and the possibility of adverse effects. Children with a past history of rheumatic fever or those living in a region with a high prevalence of this condition are more likely to benefit from antibiotics than those without these risk factors. Oral corticosteroids can decrease sore throat symptoms within the first day and may be helpful for children with severe symptoms of infectious mononucleosis. There is no compelling evidence that any Chinese herbal medicine has beneficial effects for the relief of sore throat symptoms or prevention of sequelae. Copyright Β© 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration