| Summary: | <h4>Background</h4> <p>Guidelines recommend prolonged treatment courses for acute sore throat but shorter courses may be used in practice. </p> <h4>Aim</h4> <p>To determine whether antibiotic duration and class predicts adverse outcome of acute sore throat in adults in routine care. </p> <h4>Design and setting</h4> <p>A secondary analysis of a prospective cohort study of 14610 adults presenting with acute sore throat in primary care.</p> <h4>Methods</h4> <p>A brief clinical proforma was used to collect symptom severity and examination findings at presentation. Outcomes were collected by notes review and in a sample a symptom diary. Primary outcome: Re-consultation with new/non-resolving symptoms within 1 month. Secondary outcome ‘global’ poorer symptom control (longer than the median duration or higher than median severity). </p> <h4>Results</h4> <p>Antibiotics were prescribed for 60% (8572/14610) of participants. The most commonly prescribed antibiotic was phenoxymethylpenicillin (76%, 5656/7474) and prescription durations were 5 (20%), 7 (57%), or 10 (22%) days.. Compared with 5 day courses those receiving longer courses were less likely to re-consult with new or worsening symptoms 5 days 15.3%, 7 days 13.9%, 10 days 12.2%, (7 day course adjusted risk ratio 0·92 (0·76, 1·11) and 10 days 0·86 (0·59, 1·23)) but this difference did not reach statistical significance. </p> <h4>Conclusions</h4> <p>In adults prescribed antibiotics for sore throat, we cannot rule out a small advantage in terms of reduced re-consultation for a 10 day course of penicillin but that effect is likely to be small.</p>
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