Antibiotics for pharyngitis? Test first, prescribe after.

Understanding when antibiotics are appropriate

Pharyngitis is one of the most common conditions seen in primary care, especially during cold and flu season. As health care providers, you often face pressure from patients seeking antibiotics to treat their sore throats. However, the evidence consistently supports that antibiotics should not be routinely prescribed for pharyngitis as most cases are viral and resolve on their own.

Prescribing antibiotics when unnecessary not only provides no benefit to the patient, but can increase the risk of side effects and antibiotic resistance.

When antibiotics are appropriate

While Group A Streptococcus (GAS) is the most common bacterial cause of pharyngitis, it only accounts for about 10–20% of cases in adults and 20–30% in children. Clinical guidelines recommend confirming a bacterial infection before prescribing antibiotics. Rapid antigen detection tests (RADTs) and throat cultures can help identify Group A Streptococcus infections. For those with GAS, antibiotics like penicillin are effective and can reduce the risk of complications (e.g., rheumatic fever).

Supportive care as first-line treatment

A negative RADT result combined with clinical judgment should be used to avoid unnecessary antibiotic prescriptions. For viral pharyngitis, treatment is supportive. Educating patients on the self-limited nature of viral pharyngitis can help set expectations and reduce the pressure to prescribe antibiotics.