Antibiotics for Uncomplicated Sore Throat Offer Minimal Protection Against Invasive Group A Streptococcal Infection: Study
Sweden: A study published in the International Journal of Infectious Diseases found that prescribing antibiotics for uncomplicated sore throat prevents only a small proportion of invasive Group A Streptococcus (iGAS) cases—up to 6.7% in children and 2.8% in adults. Even a targeted prescribing strategy prevented fewer cases, with reductions of only 1.6% in children and 1.2% in adults.
The analysis demonstrated an extremely high number needed to treat (NNT), ranging from 12,000 to 110,000, and 45,000 to 110,000 throat swabs would be required to prevent a single case of iGAS. These findings suggest that routine antibiotic use for uncomplicated sore throat is not justified, given the minimal preventive benefit, potential adverse effects, and the risk of promoting antimicrobial resistance.
The findings were published in the International Journal of Infectious Diseases by Ronny Gunnarsson from the School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Sweden, and colleagues.
Group A Streptococcus (GAS) is a common cause of sore throat but can occasionally progress to invasive Group A Streptococcus, a serious and potentially life-threatening infection. To determine whether antibiotic treatment for uncomplicated sore throat can reduce the population burden of iGAS, researchers conducted a critical analysis of the available evidence.
For this purpose, they combined published evidence with Swedish nationwide epidemiological data from 2024. The study estimated the proportion of iGAS cases that could be prevented with antibiotic treatment and calculated the number of throat swabs and antibiotic prescriptions required to prevent one case. The analysis also compared prescribing strategies based on the Centor score.
The findings showed that even universal throat swabbing and antibiotic treatment for GAS-positive patients would prevent only a small proportion of iGAS cases, with even smaller benefits when testing and treatment were limited to patients with higher Centor scores.
The key findings included:
- Treating all patients with uncomplicated sore throat who tested positive for GAS could prevent up to 6.7% of iGAS cases in children and up to 2.8% in adults.
- Limiting throat swabbing and antibiotic treatment to patients with 3–4 Centor criteria reduced preventable iGAS cases to 1.6% in children and 1.2% in adults.
- Between 45,000 and 110,000 throat swabs would be required to prevent a single case of iGAS.
- The number needed to treat with antibiotics to prevent one iGAS case ranged from 12,000 to 110,000.
The researchers concluded that routine antibiotic treatment for uncomplicated acute sore throat prevents very few cases of invasive Group A Streptococcus infection while exposing many patients to unnecessary antibiotics. They emphasized that the limited benefit is outweighed by the risks of adverse effects, increased primary care workload, and antimicrobial resistance, and therefore should not justify routine antibiotic prescribing.
Reference:
Gunnarsson R, Wiezell E, Wikberg C, Sundvall PD, Rystedt K. Antibiotics for the uncomplicated acute sore throat to prevent invasive group A Streptococcus - a critical analysis of current evidence. Int J Infect Dis. 2026 Aug;169:108818. doi: 10.1016/j.ijid.2026.108818. Epub 2026 May 22. PMID: 42176799.
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