Sore Throat: Avoid Overcomplicating the Uncomplicated

Jeffrey A. Linder

doi:10.7326/L15-5100-2

Letters |16 June 2015

Sore Throat: Avoid Overcomplicating the Uncomplicated

Jeffrey A. Linder, MD, MPH

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IN RESPONSE:

I agree with Dr. Centor about quite a lot in the management of patients with sore throat. In developed countries, rheumatic fever is a minor concern. Patients with Centor scores of 0 or 1 can be safely reassured. Those diagnosed with bacterial pharyngitis should be treated with penicillin. Physicians should not be overly anchored to guidelines if their patients are not doing well. The Lemierre syndrome can be devastating. However, we have legitimate disagreements. Dr. Centor's arguments recall other examples of injudicious antibiotic use.

The use of empirical penicillin to prevent the Lemierre syndrome is reminiscent of the discredited practice of antibiotic prophylaxis for patients with heart murmurs to prevent infective endocarditis. Even if Fusobacterium pharyngitis were clearly linked to the Lemierre syndrome, only a tiny fraction of patients with Fusobacterium pharyngitis will develop the Lemierre syndrome. Dr. Centor has estimated it to be 1 in 400 (1), but the rate could be much, much lower (2). There is no evidence that antibiotics prevent the Lemierre syndrome.

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Letters |16 June 2015

Sore Throat: Avoid Overcomplicating the Uncomplicated

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Letters |16 June 2015

Sore Throat: Avoid Overcomplicating the Uncomplicated

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