Del Mar C B, Glasziou P P, Spinks A B
Centre for General Practice, University of Queensland Medical School, Brisbane Queensland 4006, Australia.
Cochrane Database Syst Rev. 2000(2):CD000023. doi: 10.1002/14651858.CD000023.
Sore throat is a very common reason for people to attend for medical care. Sore throat is a disease that remits spontaneously, that is, 'cure' is not dependant on treatment. Nonetheless primary care doctors commonly prescribe antibiotics for sore throat and other upper respiratory tract infections.
To assess the benefits of antibiotics in the management of sore throat.
Systematic search of the literature from 1945 to 1999, using electronic searches of MEDLINE (using the keywords, "pharyngitis", "sore throat" and "tonsillitis") after 1966, the Cochrane Library, the Cochrane collection of hand-searched trials, and the reference sections of the articles identified. Abstracts of identified articles were used to determine which studies were trials.
Trials of antibiotic against control with either measures of the typical symptoms (throat soreness, headache or fever), or complications (suppurative and non-suppurative) of sore throat.
RevMan 4.0.3
A total number of 10,484 cases of sore throat have been studied. 1. Non-suppurative complications There was a trend for protection against acute glomerulonephritis by antibiotics, but insufficient cases were recorded to be sure of this effect. Several studies found benefit from antibiotics for acute rheumatic fever, which reduced this complication to less than one third (OR = 0.30; 95% CI = 0.20-0.45). 2. Suppurative complications Antibiotics reduced the incidence of acute otitis media to about one quarter of that in the placebo group (OR = 0.22; 95% CI = 0.11-0.43) and reduced the incidence of acute sinusitis to about one half of that in the placebo group (OR = 0.46; 95% CI = 0.10-2.05). The incidence of quinsy was also reduced in relation to placebo group (OR = 0.18; 95% CI = 0.08-0.43). 3. Symptoms Symptoms of headache, throat soreness and fever were reduced by antibiotics to about one half. The greatest time for this to be evident was at about three and a half days (when the symptoms of about 50% of untreated patients had settled). About 90% of treated and untreated patients were symptom-free by one week. 4. Subgroup analyses of symptom reduction Subgroup analysis by age; blind vs unblinded; us of antipyretics; or results of swabs for Streptococcus yielded no significant differences.
REVIEWER'S CONCLUSIONS: Antibiotics confer relative benefits in the treatment of sore throat. However, the absolute benefits are modest. Protecting sore throat sufferers against suppurative and non-suppurative complications in modern Western society can only be achieved by treating many with antibiotics who will derive no benefit. Antibiotics shorten the duration of symptoms, but by a mean of only about half of one day at day 3 (the time of maximal effect), and by about eight hours overall.
喉咙痛是人们就医的常见原因。喉咙痛是一种可自愈的疾病，也就是说，“治愈”并不依赖于治疗。尽管如此，初级保健医生通常会为喉咙痛及其他上呼吸道感染开抗生素。
评估抗生素在治疗喉咙痛方面的益处。
系统检索1945年至1999年的文献，1966年后通过电子检索MEDLINE（使用关键词“咽炎”“喉咙痛”和“扁桃体炎”）、考克兰图书馆、考克兰手工检索试验集以及已识别文章的参考文献部分。已识别文章的摘要用于确定哪些研究为试验。
对比使用抗生素与对照治疗，采用典型症状（喉咙疼痛、头痛或发烧）或喉咙痛并发症（化脓性和非化脓性）的测量指标的试验。
RevMan 4.0.3
共研究了10484例喉咙痛病例。1. 非化脓性并发症 抗生素有预防急性肾小球肾炎的趋势，但记录的病例数不足，无法确定这一效果。多项研究发现抗生素对急性风湿热有益，可将该并发症减少至不到三分之一（比值比=0.30；95%置信区间=0.20-0.45）。2. 化脓性并发症 抗生素将急性中耳炎的发生率降低至安慰剂组的约四分之一（比值比=0.22；95%置信区间=0.11-0.43），并将急性鼻窦炎的发生率降低至安慰剂组的约二分之一（比值比=0.46；95%置信区间=0.10-2.05）。扁桃体周围脓肿的发生率相对于安慰剂组也有所降低（比值比=0.18；95%置信区间=0.08-0.43）。3. 症状 抗生素可将头痛、喉咙疼痛和发烧症状减轻约一半。最明显的时间约为三天半（此时约50%未治疗患者的症状已缓解）。约90%接受治疗和未接受治疗的患者在一周内无症状。4. 症状减轻的亚组分析 按年龄、盲法与非盲法、使用退烧药或链球菌拭子结果进行亚组分析，未发现显著差异。
抗生素在治疗喉咙痛方面有相对益处。然而，绝对益处不大。在现代西方社会，要保护喉咙痛患者免受化脓性和非化脓性并发症的影响，只能通过给许多不会从中受益的人使用抗生素来实现。抗生素可缩短症状持续时间，但在第三天（效果最大时）平均仅缩短约半天，总体缩短约八小时。
