Sore throat: Can antibiotics make it go away faster?
Taking antibiotics for a sore throat can shorten the duration of symptoms by between half a day and one day if bacteria are the probable cause. There is a risk of side effects, though. And using antibiotics too often can make bacteria more resistant.
Sore throats are a common reason to go to the doctor – particularly during the cold season. The cause is most likely a “normal” cold, but it might also be pharyngitis (inflammation of the throat) or tonsillitis (inflammation of the tonsils). Then you might have to decide whether or not to take antibiotics. But most people do not benefit from taking antibiotics: Sore throats due to a cold are usually caused by viruses, which antibiotics have no effect on. People with a bacterial infection of the throat, such as bacterial tonsillitis, are more likely to benefit from antibiotics.
Find more information on this topic in our feature.
Some symptoms can help give us an idea whether bacteria or viruses are causing the sore throat. Someone who has swollen tonsils with a yellowish coating, and also has fever but no cough, might have bacterial tonsillitis. To find out, a sample can be taken from the back of the throat or from the tonsils and then immediately tested. This test is called the rapid streptococcal test, and although it is very fast, its results are not very accurate. The results are more reliable if the sample is sent to a lab to check it for bacteria. In practice this is not commonly done, because it takes two or three days to get back the results. So antibiotics are often prescribed only based on the symptoms a person has. That means that some of the people who take antibiotics will not benefit from them because their tonsillitis is viral, and not bacterial.
Research has shown that sore throats usually get better by themselves without special treatment. It was found that 34 out of every 100 people already feel a lot better about three days after the sore throat starts. About 82 out of every 100 people no longer have a sore throat after a week, even without treatment. Even when a person also has a fever, this too usually goes away without treatment after three days.
Benefits of antibiotic therapy
With such a high rate of spontaneous recovery, how much can people who have a sore throat really benefit from drugs like antibiotics? Researchers from the Cochrane Collaboration – an international network of researchers – analyzed 27 trials, in which more than 12,800 people took part. In each trial, one group took antibiotics and another took a fake medicine (placebo). Some of the people in the trials had a confirmed bacterial infection. In most cases, though, it was assumed that the infection was caused by bacteria, based on the symptoms and a physical examination.
The trials show that taking antibiotics can speed up recovery somewhat:
51 out of 100 people who took antibiotics no longer had a sore throat three days after the symptoms had started.
In comparison, 34 out of 100 people who did not take antibiotics were over their sore throat by the third day.
On average, sore throats can be shortened by about 16 hours, which is less than one day.
After a week there was no longer much difference between the two groups: 87 out of 100 people who took antibiotics were free of symptoms, and so were 82 out of 100 people who did not take antibiotics.
In about 1,800 out of the 12,800 participants, bacteria were detected by taking a sample. These bacteria are one possible cause of bacterial tonsillitis. The benefit of antibiotics was slightly greater in this group of people:
56 out of 100 people who took antibiotics no longer had a sore throat three days after the symptoms had started.
In comparison, 29 out of 100 people who did not take antibiotics were over their sore throat by the third day.
One other impact of antibiotics was that they reduced the likelihood of complications, including middle ear infections. Build-up of pus in the throat (known as a peritonsillar abscess or quinsy) is probably less common too. But these kinds of complications are also fairly uncommon in otherwise healthy people who do not have any treatment. At the most, they occur in about 1 to 10 out of 1,000 people who go to a doctor because of their symptoms.
Side effects of antibiotics
The benefits of antibiotics in the treatment of sore throat need to be weighed against their side effects. Other trials have found that about 10 out of every 100 adults will experience side effects from antibiotics. The most common side effects include diarrhea and skin rash. Also, germs can become resistant (unresponsive) to antibiotics if these drugs are overused in treating mild medical conditions. This means that a lot of serious conditions can no longer be treated as successfully as they used to be. You can find out more about using antibiotics in our fact sheet “The safe use of antibiotics.” You can read more about colds, their prevention and the treatment options in our feature on the common cold.
Published by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany)
Next planned update: April 2016. You can find out more about how our health information is updated in our text "Informed Health Online: How our information is produced."
IQWiG health information is based on research in the international literature. We identify the most scientifically reliable knowledge currently available, particularly what are known as “systematic reviews.” These summarize and analyze the results of scientific research on the benefits and harms of treatments and other health care interventions. This helps medical professionals and people who are affected by the medical condition to weigh up the pros and cons. You can read more about systematic reviews and why these can provide the most trustworthy evidence about the state of knowledge in our information “Evidence-based medicine.” We also have our health information reviewed to ensure medical and scientific accuracy.